2017—2019年南京医科大学附属逸夫医院耐碳青霉烯类革兰阴性菌的分布及耐药性分析

Distribution and antimicrobial susceptibility characters of carbapenems resistant Gram-negative bacteria strains of Sir Run Run Hospital of Nanjing Medical University from 2017 to 2019

目的分析南京医科大学附属逸夫医院耐碳青霉烯类革兰阴性菌的临床分布特征以及耐药情况,为医院感染的控制和临床治疗策略的优化提供参考。方法对2017—2019年南京医科大学附属逸夫医院耐碳青霉烯类革兰阴性菌菌株标本类型、科室分布、年龄分布、菌株种类和耐药性特点进行统计和分析。结果2017—2019年南京医科大学附属逸夫医院共分离得到耐碳青霉烯类革兰阴性菌591株,平均分离率为11.7%,其中耐碳青霉烯类鲍曼不动杆菌(CRAB)198株(33.5%),与耐碳青霉烯类铜绿假单胞菌(CRPA)和耐碳青霉烯类肠杆菌科细菌(CRE)的分离率相比较高,差异显著(P<0.05);分离耐碳青霉烯类革兰阴性菌的标本主要为痰和肺泡灌洗液(402株,68.0%),差异显著(P<0.05);耐碳青霉烯类革兰阴性菌的分布人群集中在61~90岁,其中81~90岁的耐碳青霉烯类革兰阴性菌的分离率与其他年龄段相比较高,差异显著(P<0.05);耐碳青霉烯类革兰阴性菌主要分布于ICU(37.7%),呼吸科病房(23.7%),神经外科病房(12.4%)及老年医学科病房(7.6%),其检出率与其他科室相比均较高,差异显著(P<0.05);CRE菌株对阿米卡星的耐药率与其他抗菌药物相比较低,差异显著(P<0.05),CRAB对临床常用抗菌药物均呈高度耐药(平均耐药率>94.3%),CRPA菌株对阿米卡星的耐药率与其他抗菌药物相比较低,差异显著(P<0.05)。结论南京医科大学附属逸夫医院耐碳青霉烯类革兰阴性菌分离率较高,且高度耐药。本研究为医院感染控制策略的优化提供基线实验数据,同时强调在防控多重耐药菌播散中持续监测耐药性以及规范使用抗菌药物的必要性。

Objective To investigate the clinical distribution characteristics and drug resistance of CRGN(carbapenems resistant Gram-negative bacteria)in Sir Run Run Hospital of Nanjing Medical University,and to offer evidence to hospital infection control and clinical therapy strategy.Methods The data of isolated CRGN strains during 2017—2019 were collected and analyzed by their sample type,clinical department distribution,age distribution,strain distribution and drug resistance rate.Results Total amount of isolation of CRGN from 2017 to 2019 is 591(average isolation rate 11.7%)strains.The isolation of CRAB(Carbapenem-resistant Acinetobacter baumannii)strains(198 strains,33.5%)was statistically significantly higher than both the isolation of CRPA(Carbapenem-resistant Pseudomonas aeruginosa)and CRE(Carbapenem-resistant Enterobacteriaeae)(P<0.05).The most samples that isolated CRGN was sputum and Bronchoalveolar Lavage Fluid(BALF)sample(402 strains,68.0%),which was statistically significantly higher than the other samples(P<0.05).The age of patients that isolated was mainly ranged from 61 to 90,amongst them the isolation of CRGN between 81 and 90 was statistically significantly higher than the other age ranges(P<0.05).The CRGN mainly distributed in Intensive care unit(ICU)(37.7%),Respiratory(23.7%),Neurosurgery(12.4%)and Geriatrics(7.6%)department.The isolation rates of these departments were statistically significantly higher(P<0.05).The drug resistance rate of CRE strains towards amikacin was statistically significantly lower than the other antibiotics(P<0.05).CRAB was highly resistant towards antibiotics commonly used in clinic(the average drug resistance rate>94.3%).Conclusion The rate of isolation of CRGN strains was high,and the drug resistance towards antibiotics was severe in the Tertiary hospital.This study offers baseline data to optimize the strategy of hospital infection control,and emphasize the importance of monitoring the bacteria resistance and the necessity of rationalization of antibiotics use.