威海地区8家医院多重耐药菌分布特征

Distribution characteristics of multidrug-resistant bacteria in 8 hospitals in Weihai District

目的了解山东省威海地区多重耐药菌(MDR)的临床分布及流行状况,为预防控制MDR感染的暴发流行提供参考依据。方法收集2017年10月1日-2018年9月30日威海地区8家教学医院(3家三级甲等综合性医院、3家三级甲等专科医院、2家二级甲等医院)送检的各类标本,按照统一方案进行细菌培养鉴定及耐药性检测,采用纸片扩散法(K-B法)、自动化仪器法进行药敏试验,按照美国临床实验室标准化协会(CLSI)2017年版标准判读结果,用Whonet 5.6软件统计分析分离菌的临床分布特点。结果威海地区8家医院1年内共检出10 218株细菌,MDR为2 077株,检出率20.33%,其中大肠埃希菌(Eco)、鲍曼不动杆菌(Aba)、肺炎克雷伯菌(Kpn)、铜绿假单胞菌(Pae)、金黄色葡萄球菌MDR总检出率分别为51.18%、10.83%、18.92%、7.08%、11.99%。分离出的MDR主要包括产超广谱β-内酰胺酶大肠杆菌(ESBLs-Eco)、产超广谱β-内酰胺酶肺炎克雷伯菌(ESBLs-Kpn)、耐甲氧西林金黄色葡萄球菌(MRSA)、耐碳青霉烯类鲍曼不动杆菌(CR-Aba)、耐碳青霉烯类铜绿假单胞菌(CR-Pae),分别占各类病原菌的44.10%(1 076/2 440)、25.64%(391/1 525)、17.47%(253/1 448)、52.28%(218/417)、13.94%(149/1 069)。MDR多分布在ICU(16.47%)、神经外科(7.51%)、泌尿外科(6.45%)、神经内科(3.80%)、呼吸内科(3.37%)等。在痰液标本的检出率最高(28.36%),其次为尿液标本(24.69%)和分泌物标本(16.99%)。结论威海地区MDR感染状况严峻,临床应加强MDR的监测与管理,减少MDR菌株的产生,避免其在院内播散。

Objective To understand the clinical distribution and epidemic status of multidrug-resistant bacteria and provide reference evidences for the prevention and control of the epidemic outbreak of multidrugresistant bacteria(MDR) infection. Methods From October 1, 2017 to September 30, 2018, all kinds of specimens were collected from 8 teaching hospitals(3 Grade three A comprehensive hospitals, 3 Grade three A specialized hospitals, 2 Grade two A hospitals) in Weihai district. According to a unified plan, the identification of the bacterial cultures and detection of drugs resistance were carried out, the disc diffusion method(K-B method) and automation instrument method were used to perform drug sensitive tests, based on the standards in American Clinical Laboratory Standardization Institute(CLSI) of 2017 edition, the results were interpreted, and Whonet 5.6 statistical software was used to analyze the clinical distribution characteristics of isolated bacteria. Results A total of 10 218 strains of bacteria were detected in 8 hospitals in Weihai district within one year, and 2 077 strains of MDR were detected, the detection rate being 20.33%. Of them, the total MDR detection rates of Escherichia coli, Acinetobacter bowman, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus were 51.18%, 10.83%,18.92%, 7.08% and 11.99%, respectively. The isolated MDR mainly included Escherichia coli producing extended beta-lactamase(ESBLs-Eco), Klebsiella pneumonia producing extended beta-lactamase(ESBLs-kpn), methicillinresistant Staphylococcus aureus(MRSA), carbapenem-resistant Acinetobacter bowman(CR-Aba) and carbapenemresistant Pseudomonas aeruginosa(CR-Pea), accounting for 44.10%(1 076/2 440), 25.64%(391/1 525), 17.47%(253/1 448), 52.28%(218/417) and 13.94%(149/1 069) of its own total strains of pathogenic bacteria, respectively.MDR were mainly distributed in ICU(16.47%), Neurosurgery(7.51%), Urology(6.45%), Neurology(3.80%),Respiratory Medicine(3.37%) Departments, etc. The highest detection rate was found in sputum(28.36%), followed by urine(24.69%) and secretions(16.99%) specimens. Conclusions The infection situation of multi-drug resistant bacteria in Weihai District is severe. The monitoring and management of multi-drug resistant bacteria should be strengthened in clinics to reduce the generation of multi-drug resistant strains and avoid their spread in hospitals.