耐碳青霉烯类革兰阴性菌的耐药性及影响因素

Drug Resistance of Carbapenem-resistant Gram-negative Bacteria and its Influencing Factors

目的了解某院主要耐碳青霉烯类革兰阴性杆菌(CR-GNB)的临床分布及耐药性,分析感染特征及危险因素,为临床干预治疗提供理论依据。方法2017年1月至2020年1月在某院收集CR-GNB,应用珠海迪尔DL-96Ⅱ全自动细菌分析仪进行鉴定和药敏试验。采用单因素分析及多因素Logistic回归分析探讨医院CR-GNB感染的危险因素。结果共检出CR-GNB 505株,以非发酵菌数量最多(275株,54.45%),主要分布在ICU(231株,45.74%)。标本种类以痰液为主(278株,55.05%)。细菌对常见药物耐药率>80.00%且表现为多重耐药,鲍曼不动杆菌对多粘菌素B耐药率最低;铜绿假单胞菌对多粘菌素B和阿米卡星较敏感;肺炎克雷伯杆菌对阿米卡星、复方新诺明耐药率较低;大肠埃希菌对呋喃妥因敏感率较高;黏质沙雷菌对阿米卡星和复方新诺明耐药率<10.00%。住院时间>14 d、入住ICU、手术治疗、脑血管病、肿瘤、气管插管、留置胃管是CR-GNB感染的独立危险因素。结论CR-GNB以非发酵菌为主,且多重耐药情况严重,可选择药物种类有限。感染具有多个独立危险因素,临床医生需制定合理抗感染治疗方案,以减少CR-GNB的产生。

Objective To understand the clinical distribution and drug resistance of major carbapenems gram-negative bacilli(CR-GNB)in a hospital,analyze infection characteristics and risk factors,and provide theoretical basis for clinical intervention treatment.Methods We collected CR-GNB clinically separated from a hospital from January 2017 to January 2020,and used Zhuhai DL-96Ⅱ,an automatic bacteria analyzer,for identification and drug susceptibility testing.Univariate analysis and multivariate Logistic regression analysis were used to investigate the risk factors of hospital CR-GNB infection.Results A total of 505 CR-GNB strains were detected,of which the number of non-fermentative bacteria was the largest(275 strains,54.45%),mainly distributed in ICU(231 strains,45.74%).Sputum was the main sample(278 strains,55.05%).The bacteria showed multi-drug resistance rate of>80.00%to common drugs,and acinetobacter baumannii had the lowest resistance rate to polymyxin B;Pseudomonas aeruginosa was more sensitive to polymyxin B and amikacin;Klebsiella pneumoniae had a lower resistance rate to amikacin and co-trimoxazole;Escherichia coli was more sensitive to nitrofurantoin;The resistance rate of Serratia marcescens to amikacin and co-trimoxazole was<10.00%.Length of hospitalization over 14 days,admission to ICU,hypoproteinemia,surgical treatment,cerebrovascular disease,tumor,tracheal intubation,and indwelling gastric tube are independent risk factors for CR-GNB infection.Conclusion Among the CR-GNB,non-fermentative bacteria were dominant,and their multi drug resistance was serious,so the range of drugs available was limited.Since infections have multiple independent risk factors,clinicians should formulate a reasonable anti-infection treatment plan to reduce the production of CR-GNB.