某院急诊科多重耐药菌致重症感染患者的病原菌分布与耐药情况分析

Analysis of Distribution and Drug Resistance of Pathogenic Bacteria in Patients with Severe Infection Caused by MDRO in the Emergency Department of a Hospital

目的:分析医院急诊科多重耐药菌致重症感染患者的病原菌分布与耐药特点,为临床抗菌药物的合理使用提供参考。方法:选取2018年3月—2020年9月武陟县人民医院急诊科收治的58例多重耐药菌致重症感染患者作为研究对象,统计和分析患者标本中病原菌的分布和主要病原菌的耐药特点。结果:58例多重耐药菌致重症感染患者标本中分离出病原菌92株,其中以鲍曼不动杆菌(33株,占35.87%)、铜绿假单胞菌(15株,占16.30%)和金黄色葡萄球菌(13株,占14.13%)检出最多;药敏试验结果显示,鲍曼不动杆菌仅对替加环素的耐药率较低(<20.00%),对其他抗菌药物的耐药率均较高(>40.00%);铜绿假单胞菌仅对左氧氟沙星和亚胺培南的耐药率相对较低(均为33.33%),对其他抗菌药物的耐药率均较高(≥40.00%);大肠埃希菌对亚胺培南、厄他培南和替加环素的耐药率较低(<15.00%);金黄色葡萄球菌和凝固酶阴性葡萄球菌同时对达福普汀、利福平、呋喃妥因、替考拉宁、万古霉素和替加环素有很低的耐药率(<10.00%)。结论:医院急诊科多重耐药菌致重症感染患者的主要致病菌为鲍曼不动杆菌、铜绿假单胞菌和金黄色葡萄球菌,临床应根据病原菌种类及其药敏结果,科学合理选用抗菌药物,同时不定期开展细菌耐药监测,为制定合理抗感染治疗方案提供参考。

Objective: To analyze the distribution and drug resistance characteristics of pathogenic bacteria in patients with severe infection caused by multi-drug resistant organisms(MDRO) in the emergency department of the hospital,and provide reference for the rational use of clinical antibacterial drugs. Methods: 58 patients with severe infection caused by MDRO who were admitted to the emergency department of Wuzhi County People’s Hospital from March2018 to September 2020 were selected as study subjects, and statistics and analysis of the distribution of pathogenic bacteria and drug resistance characteristics of major pathogenic bacteria in patient specimens were conducted. Results:92 strains of pathogenic bacteria were isolated from the specimens of 58 patients with severe infection caused by MDRO,among which, the most frequent strains of Acinetobacter baumannii(33 strains, accounting for 35.87%), Pseudomonas aeruginosa(15 strains, accounting for 16.30%) and Staphylococcus aureus(13 strains, accounting for 14.13%) were detected. The drug susceptibility test showed that Acinetobacter baumannii had a low resistance rate(<20.00%) to tigecycline only, and had a high resistance rate(>40.00%) to other antibacterial drugs;Pseudomonas aeruginosa had a low resistance rate(both 33.33%) to levofloxacin and imipenem only, and had a high resistance rate(≥ 40.00%) to other antibacterial drugs;Escherichia coli had a low resistance rate(<15.00%) to imipenem, ertapenem and tigecycline;both Staphylococcus aureus and coagulase-negative staphylococci had very low resistance rates(<10.00%) to dalfopristin,rifampin, furantoin, teicoplanin, vancomycin, and tigecycline. Conclusion: The main pathogenic bacteria of patients with severe infection caused by MDRO in the emergency department of the hospital are Acinetobacter baumannii,Pseudomonas aeruginosa and Staphylococcus aureus, so clinical antibacterial drugs should be selected scientifically and reasonably according to the pathogenic species and drug susceptibility results, meanwhile, bacterial drug resistance monitoring should also be conducted from time to time to provide reference for the development of reasonable antiinfection treatment regimens.