神经外科碳青霉烯耐药革兰阴性菌医院感染与社区感染分布及耐药性分析

Analysis of distribution and drug resistance of nosocomial infection and community infection of carbapenem-resistant organism in neurosurgery

目的探讨神经外科住院患者碳青霉烯耐药革兰阴性菌(Carbapenem-resistant Organism,CRO)医院感染与社区感染病原菌及耐药性特点。方法回顾性调查2016年1月-2019年10月苏州大学附属第一医院13022例神经外科住院患者的临床资料和微生物信息,根据感染的来源将感染患者489例分为医院性感染者263例与社区性感染226例,并分析医院感染与社区感染CRO感染部位和耐药性。结果神经外科住院患者CRO感染489例,其中医院感染263例(53.78%);社区感染226例(46.22%)。两组患者CRO感染部位均以呼吸系统为主,医院感染患者以碳青霉烯类耐药的肺炎克雷伯菌(CR-KPN)为主,社区感染患者以CR-KPN和碳青霉烯类耐药鲍氏不动杆菌(CR-ABA)为主,碳青霉烯类耐药的大肠埃希菌(CR-ECO)感染均较少。两组患者CR-KPN对多数临床常用抗菌药物呈高度耐药性,仅对替加环素的耐药率最低,分别为15.65%和11.84%,其次对磺胺甲噁唑/甲氧苄啶耐药率较低,且两组间差异均无统计学意义。两组患者CR-ABA对替加环素敏感,其次两组对阿米卡星和头孢哌酮/舒巴坦的耐药率较低。社区感染患者CR-ABA对四环素耐药率70.00%高于医院感染患者48.28%(P=0.047)。医院感染患者碳青霉烯类耐药铜绿假单胞菌(CR-PAE)未发现诺氟沙星、妥布霉素、庆大霉素的耐药株,社区感染患者对其耐药率为12.20%~17.07%;其次对阿米卡星、头孢他啶、头孢吡肟均较为敏感;社区感染患者对哌拉西林、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、左氧氟沙星以及环丙沙星的耐药率高于医院感染患者(P<0.05)。结论神经外科住院患者医院感染和社区感染CRO以呼吸系统为主,耐药率存在一定差异,应加强CRO所致感染分布和耐药监测,科学合理用药,有效控制感染和减缓碳青霉烯类耐药过快增长和传播。

OBJECTIVE To investigate the characteristics of pathogenic bacteria and drug resistance of nosocomial infection and community infection of carbapenem-resistant organism(CRO)in hospitalized patients in neurosurgery.METHODS The clinical data and microbial information of 13022 nurosurgery inpatients in the First Affiliated Hospital of Soochow University from Jan.2016 to Oct.2019 were retrospectively analyzed,and divided into 263 cases of nosocomial infection group and 226 cases of communit-acquired infection group(226 cases)according to the source of infection.The distribution of infection sites and drug resistance rate of CRO of nosocomial infection and community infection were analyzed observed and compared between the two groups.RESULTS There were 489 cases of neurosurgery inpatients with CRO infection,including 263(53.78%)cases of nosocomial infection and 226(46.22%)cases of community-acquired infection.The CRO infection sites of the two groups of patients were mainly the respiratory system.The nosocomial infection patients were mainly carbapenem-resistant Klebsiella pneumonia(CR-KPN),and the community infection patients were mainly carbapenem-resistant Klebsiella pneumoniae(CR-KPN)and carbapenem-resistant Acinetobacter baumannii(CR-ABA),and Carbapenem-resistant Escherichia coli(CR-ECO)infection was rarely detected among the two groups.CR-KPN of the two groups of patients was highly resistant to most commonly used clinical antibiotics,only the lowest resistance rate to tigecyclin,which was 15.65%and 11.84%respectively.Secondly,the resistance rate to sulfamethoxazole/trimethoprim was low,and the difference between the two groups was not significnat.CR-ABA was sensitive to tigecyclin,and the resistance rate of amikacin and cefoperazone/sulbactam were lower between the two groups.The resistance rate of CR-ABA to tetracycline in community infection group was 70.00%,significantly higher than that in nosocomial infection group(48.28%).Carbapenem-resistant Pseudomonas aeruginosa(CR-PAE)strains in nosocomial infection patients were not found to be resistant to norfloxacin,tobramycin and gentamycin.The drug-resistant rate of community-acquired infection patients was 12.20%-17.07%,and they are more sensitive to amikacin,ceftazidime and cefepime.The drug resistance rate of community infected patients to piperacillin,piperacillin/tazobactam,cefoperazone/sulbactam,levofloxacin and ciprofloxacin was significantly higher than that of nosocomial infection group.CONCLUSION The chief infection sites of nosocomial infection and community infections of neurosurgery inpatients with carbapenem-resistant organism was mainly in the respiratory system,and there were certain differences in drug resistance rate.The monitoring on the distribution and drug resistance of carbapenem-resistant organism should be strengthened,and drugs should be used scientifically and rationally to effectively control infection and slow down the rapid growth and spread of carbapenem resistance.