2018至2020年六安市中医院多重耐药菌株分布、标本来源及科室分布

Distribution of multi-drug resistant micro-organisms,the source of specimens and the department distribution in Lu’an City Hospital of Traditional Chinese Medicine from 2018 to 2020

目的:探讨2018至2020年六安市中医院感染多重耐药菌(multi-drug resistant micro-organisms,MDROs)的菌株分布、标本来源以及科室分布。方法:回顾性分析六安市中医院2018至2020年各科室门诊及住院患者送检样本,进行MDROs细菌鉴定及药物敏感试验,综合评估院内MDROs的菌株分布、标本来源及其在各科室的分布情况。结果:六安市中医院2018至2020年送检样本中共分离出3285株非重复性MDROs菌株,其中肺炎克雷伯菌903株(27.49%),铜绿假单胞菌797株(24.26%),大肠埃希菌733株(23.31%),鲍曼不动杆菌559株(17.02%),耐甲氧西林的金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA)197株(6.00%),粪肠球菌6株(0.18%),其他菌株90株(2.74%)。标本来源情况:痰液1894株(57.66%),尿液701株(21.34%),血液262株(7.98%),灌洗液173株(5.27%),分泌物131株(3.99%),留置导管27株(0.82%),其他来源97株(2.95%)。科室分布:重症医学科1163株(35.40%),普外科924株(28.13%),呼吸科385株(11.72%),泌尿科176株(5.36%),康复科50株(1.52%),骨科49株(1.49%),其他科室538株(16.38%)。药敏实验结果显示:MDR肺炎克雷伯菌和MDR大肠埃希菌对于阿米卡星、环丙沙星、头孢他啶和头孢曲松的耐药率>90%,对亚胺培南、美罗培南和替加环素的耐药率<3%。MDR铜绿假单胞菌和MDR鲍曼不动杆菌对于环丙沙星、头孢他啶、亚胺培南和美罗培南的耐药率>90%,且对多种抗菌药物的耐药率均在50%以上。MRSA、MDR粪肠球菌对于头孢西汀、庆大霉素的耐药率为100%,对替拉考宁和万古霉素的耐药率为0%。结论:六安市中医院内MDROs以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌和鲍曼不动杆菌占优势,多数检出样本来源分布在普外科、重症医学科和呼吸科。院内近年来MDROs检出例数有所下降,但MDROs的耐药性呈缓慢上升趋势,临床实践中应不断加强细菌耐药的预防控制,以有效遏制MDROs的出现和感染。

Objective:To study the distribution of multi-drug resistant micro-organisms(MDROs),source of specimens and department distribution in Lu’an City Hospital of Traditional Chinese Medicine from 2018 to 2020.Methods:A retrospective analysis of the samples from outpatients and inpatients of Lu’an City Hospital of Traditional Chinese Medicine in each department from 2018 to 2020 were carried out for bacterial identification of MDROs and drug susceptibility tests,and the strain distribution of MDROs in the hospital,the source of specimens and their distribution among various departments were analyzed and evaluated.Results:A total of 3285 non-repetitive MDRO strains were isolated from the samples submitted by Liu’an Traditional Chinese Medicine Hospital from 2018 to 2020,including 903 strains of Klebsiella pneumoniae(27.49%),797 strains of Pseudomonas aeruginosa(24.26%),733 strains of Escherichia coli(23.31%),559 strains of Acinetobacter baumannii(17.02%),197 strains of MRSA(6.00%),6 strains of Enterococcus faecalis(0.18%),and 90 strains(2.74%)of other strains.Sources of specimens:1894 strains(57.66%)of sputum,701 strains(21.34%)of urine,262 strains(7.98%)of blood,173 strains(5.27%)of lavage fluid,131 strains(3.99%)of secretions,27 strains(0.82%)of vessels,97 strains(2.95%)from other sources.The distribution of the department of the specimen sources:1163 strains(35.40%)from the Department of Critical Care Medicine,924 strains(28.13%)from the Department of General Surgery,385 strains from the Department of Respiratory Medicine(11.72%),176 strains from the Department of Urology(5.36%),50 strains from the Rehabilitation Department(1.52%),49 strains(1.49%)from orthopedics,and 538 strains(16.38%)from other departments.The results of drug susceptibility experiments showed that the resistance rates of MDR Klebsiella pneumoniae and MDR Escherichia coli to amikacin,ciprofloxacin,ceftazidime and ceftriaxone were more than 90%,and the resistance rates to imipenem,meropenem and tigecycline were less than 3%.The resistance rates of MDR Pseudomonas aeruginosa and MDR Acinetobacter baumannii to ciprofloxacin,ceftazidime,imipenem and meropenem were more than 90%,and the resistance rates to multiple antibacterial drugs were above 50%.MRSA and MDR Enterococcus faecalis had a resistance rate of 100%to cefoxitin and gentamicin,and a resistance rate of 0%to tiracorine and vancomycin.Conclusion:The MDROs in Lu’an Traditional Chinese Medicine Hospital are mainly dominated by Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli,and Acinetobacter baumannii,and the sources of most of the detected samples were from the Department of General Surgery,Critical Care Medicine,and Respiratory Department.The number of detected cases of MDROs in the hospital has declined in recent years,but the drug resistance of MDROs is slowly increasing.In the clinical practice,the prevention and control of bacterial resistance should be continuously strengthened to effectively curb the emergence and infection of MDROs.