神经外科重症病房多重耐药菌治疗策略

Treatment strategy for multidrug-resistant bacteria in a Neurosurgery intensive care unit

目的探究神经外科重症病房患者多重耐药菌感染情况,为患者临床治疗提供指导。方法收集神经外科重症病房患者临床资料,监测多重耐药菌感染情况。采用PCR监测多重耐药肺炎克雷伯菌的耐药基因分布情况。结果 420例患者中有114例患者感染多重耐药菌,占27.14%。2016年感染多重耐药菌患者55例,2017年23例,2018年36例,构成比分别为29.41%、23.47%和26.67%。研究共分离140株多重耐药菌,2016-2018年在痰液、血液、脑脊液、中段尿样本中多重耐药菌分离率分别为93.57%、3.57%、2.14%和0.71%。2016-2018年分离的140株多重耐药菌中,肺炎克雷伯菌56株,鲍曼不动杆菌21株,大肠埃希菌13株,金黄色葡萄球菌8株,阴沟肠杆菌7株,醋酸钙不动杆菌6株,聚团肠杆菌4株,表皮葡萄球菌4株,溶血葡萄球菌4株,肺炎链球菌2株,屎肠球菌2株,木糖葡萄球菌2株,其他菌11株。多重耐药肺炎克雷伯菌的aac(3)-II+ant(3’)-I+rmtB、aac(3)-II+aac(6’)-I+aph(3’)-I、ant(3’)-I+rmtB、TEM-1+CTX-M-1、CTX-M-9+SHV-1、CTX-M-8+TEM-1的耐药基因检出率分别为1.79%、5.36%、44.64%、26.79%、12.50%和8.93%。结论痰液是神经外科重症病房患者感染多重耐药菌的主要样本来源,多重耐药肺炎克雷伯菌是最常见病原菌类型,耐药基因分布广泛与病原菌的高耐药性密切相关,应减少经验用药,特别是氨基糖苷类和β-内酰胺类抗生素。

Objective To investigate the prevalence of infections with multidrug-resistant bacteria in a Neurosurgery intensive care unit in order to guide the clinical treatment of patients. Methods Clinical data on patients in a Neurosurgery intensive care unit were collected to determine the prevalence of infections with multidrug-resistant bacteria. The drug resistance genes of multidrug-resistant Klebsiella pneumoniae were detected using PCR. Results Of 420 patients, 114 were infected with multidrug-resistant bacteria. Fifty-five patients(29.41%) were infected in 2016, 23(23.47%) were infected in 2017, and 36(26.67%) were infected in 2018. A total of 140 strains of multidrug-resistant bacteria were isolated. Multidrug-resistant bacteria were isolated from sputum at a rate of 93.57%, from blood at a rate of 3.57%, from cerebrospinal fluid at a rate of 2.14%, and from mid-stream urine samples at a rate of 0.71% from 2016-2018. Of the 140 strains of multiple drug-resistant strains isolated from 2016-2018, 56 were strains of Klebsiella pneumoniae, 21 were strains of Acinetobacter baumannii, 13 were strains of Escherichia coli, 8 were strains of Staphylococcus aureus, 7 were strains of Enterobacter cloacae, 6 were strains of Acinetobacter calcoaceticus, 4 were strains of E. agglomerans, 4 were strains of S. epidermidis, 4 were strains of S. haemolyticus, 2 were strains of Streptococcus pneumoniae, 2 were strains of Enterococcus faecium, 2 were strains of S. xylosus, and 11 were strains of some other bacteria. The drug resistance genes aac(3)-II+ant(3’)-I+rmtB were detected in 1.79% of multidrug-resistant K. pneumoniae, aac(3)-II+aac(6’)-I+aph(3’)-I were detected in 5.36%, ant(3’)-I+rmtB were detected in 44.64%, TEM-1+CTX-M-1 were detected in 26.79%, CTX-M-9+SHV-1 were detected in 12.50%, and CTX-M-8+TEM-1 were detected in 8.93%. Conclusion Multi-drug-resistant bacteria were most often detected in sputum samples from patients in the Neurosurgery intensive care unit. K. pneumoniae was the most common pathogenic bacterium. The wide range of drug resistance genes is closely related to the high drug resistance of pathogenic bacteria. Empirical use of aminoglycosides and -lactam antibiotics in particular should be reduced.