成都某三甲医院多重耐药菌的临床分布特点及耐药性分析

Clinical Distribution Characteristics and Drug Resistance Analysis of Multi-Drug Resistant Bacteria in a Top Three Hospital in Chengdu

目的:探讨我院分离多重耐药菌(MDRO)的临床分布及耐药变化,为临床抗菌药物的合理使用提供依据。方法:回顾性分析我院2019年1月~2019年12月住院患者送检标本分离的病原菌,对MDRO分布及其耐药性进行统计分析。结果:我院住院患者共分离出病原菌4399株,MDRO 459株,MDRO检出率为10.43%。MDRO前5位分别是碳青霉烯类耐药铜绿假单胞菌(CR-PAE,125株,占27.23%)、碳青霉烯类耐药鲍曼不动杆菌(CR-ABA,123株,占26.80%)、碳青霉烯类耐药肺炎克雷伯菌(CR-KPN,118株,占25.71%)、耐甲氧西林金黄色葡萄球菌(MRSA,74株,占16.12%)和碳青霉烯类耐药肠杆科细菌(CRE,13株,占2.83%)。在标本类型上,痰液中MDRO占所有MDRO分离株的60.57%,其次为尿液、肺泡灌洗液、分泌物和血液标本。MDRO分离株占前4位的科室分别为重症医学科、神经外科、康复医学科和干部病房。在耐药性方面,CR-ABA和CR-KPN是我院耐药最严重的菌株。CR-ABA对头孢他啶、头孢曲松和头孢吡肟、氟喹诺酮类药物(环丙沙星)、氨基糖苷类(庆大霉素和妥布霉素)均显示出较高的耐药性,为85.00%以上;对碳青霉烯类药物(亚胺培南)的耐药率在99.00%以上,替加环素对该耐药菌的敏感性较高。CR-KPN对复方新诺明、氨曲南、庆大霉素、喹诺酮类(环丙沙星和左氧氟沙星)、头孢烯类(头孢唑啉、头孢曲松、头孢西丁、头孢吡肟、头孢他啶)、β-内酰胺类与酶抑制剂复合物(氨苄西林/舒巴坦、阿莫西林/克拉维酸和哌拉西林/他唑巴坦)及碳青霉烯类抗菌药物(厄他培南和亚胺培南)的耐药率均在90.00%以上。结论:我院MDRO检出率较高,应加强MDRO耐药性监测,及时向临床医师反馈,建立沟通协作机制,促进合理选用抗菌药物,防止MDRO的感染和蔓延。

Objective:To investigate the clinical distribution and drug resistance of multidrug-resistant organism(MDRO)isolated in our hospital,and to provide reference for clinical rational use of antibiotics.Methods:The pathogens isolated from the samples of inpatients in our hospital from January 2019 to December 2019 were retrospectively analyzed,and the distribution and drug resistance of MDRO were statistically analyzed.Results:4399 strains of pathogens were isolated in our hospital,459 strains of MDRO,the detection rate of MDRO was 10.43%.The top 5 MDRO were carbapenem resistant Pseudomonas aeruginosa(CR-PAE,125 strains,accounting for27.23%),carbapenem resistant Acinetobacter baumannii(CR-ABA,123 strains,accounting for 26.80%),carbapenem resistant Klebsiella pneumoniae(CR-KPN,118 strains,accounting for 25.71%),methicillin-resistant Staphylococcus aureus(MRSA,74 strains,accounting for 16.12%)and carbapenem resistant Enterobacteriaceae(CRE,13 strains,accounting for 2.83%).In terms of specimen types,MDRO accounted for 60.57%of all MDRO isolates in sputum,followed by urine,alveolar lavage fluid,secretions and blood samples.The top four departments of MDRO isolates were ICU,neurosurgery department,rehabilitation medicine department and cadre ward.In terms of drug resistance,CR-ABA and CR-KPN were the most serious drug-resistant strains in our hospital.CR-ABA showed high resistance to ceftazidime,ceftriaxone and cefepime,fluoroquinolones(ciprofloxacin),aminoglycosides(gentamicin and tobramycin),which was more than 85.00%.The drug resistance rate of carbapenem(imipenem)was more than 99.00%,and the sensitivity of tigecycline to the resistant bacteria was higher.CR-KPN to compound sulfamethoxazole,aztreonam,gentamycin,quinolone cefepime(ciprofloxacin and levofloxacin),cephalosporins alkene(cefazolin,ceftriaxone,cefoxitin,cefepime,ceftazidime),β-lactam and enzyme inhibitors compounds(ampicillin/sulbactam,amoxicillin/clavulanic acid and piperacillin/tazobactam)and penicillium carbon alkene antimicrobial agents(ertapenem and imipenem)had drug resistance rates above 90.00%.Conclusion:The detection rate of MDRO in our hospital is high.We should strengthen the MDRO drug resistance monitoring,timely feedback to clinicians,establish a communication and cooperation mechanism,and promote the rational use of antibiotics to prevent the infection and spread of MDRO.