青海省某三级综合医院耐碳青霉烯革兰阴性菌流行特征及其抗菌药物有效性评价

Epidemiological Characteristics of Carbapenem-resistant Gram-negative Bacteria and the Evaluation of Clinical Efficacy of Antimicrobial in a Tertiary General Hospital of Qinghai Province

目的:调查本院耐碳青霉烯类革兰阴性菌(CRO)的流行特征及其治疗抗菌药物的使用,为临床合理使用抗菌药物提供理论依据。方法:回顾性分析青海省人民医院2016~2020年102例CRO感染住院患者的病历资料,调查本院耐药病原菌流行特征。根据抗感染方案将患者分为美罗培南(MEM)、亚胺培南(IPM)、头孢他啶阿维巴坦(CAZ-AVI)、头孢吡肟(FEP)、多粘菌素(CS)、替加环素(TGC)等6组,对比各组临床有效率、炎症指标变化,分析各组有效性。结果:102例患者共分离出CRO菌125株,包括7种CRO,其中最多的是耐碳青霉烯类鲍曼不动杆菌(CRAB)。患者主要分布在神经外科、重症监护病房(ICU)以及急诊ICU。不同CRO病原菌对抗菌药物的耐药性有不同程度的差异。MEM组和TCG组临床有效率分别为80.85%和86.49%,其余各组临床有效率均为100.00%;全部患者的临床总有效率为86.27%(88/102)。IPM组仅降钙素原有所下降,其余炎症指标均较前上升,而其余各组炎指标均有不同程度下降。结论:本次调查分离的主要耐药菌为CRAB,对碳青霉烯类药物耐药程度均较高;耐碳青霉烯类肺炎克雷伯菌及耐碳青霉烯类铜绿假单胞菌主要对IPM耐药。FEP的临床有效率和微生物清除率均较好,IPM对炎症指标的改善不佳。

Objective:To investigate the epidemiological characteristics of carbapenem-resistant gram-negative bacteria(CRO) and antimicrobial usage in our hospital, to provide a theoretical basis for rational use of antimicrobial. Methods:The clinical data and antimicrobial use were obtained retrospectively in Qinghai provincial hospital from June 2016 to July 2020. To investigate the epidemic characteristics of CRO. All patients received meropenem(MEM), imipenem(IPM), ceftazidime-avibactam(CAZ-AVI), cefepime(FEP), polymyxin(CS) or tigecycline(TCG) divided into six groups according to its anti-infective protocol. The changes of clinical effective rate and inflammatory index were compared between groups, and the effectiveness of each group was analyzed. Results:A total of 125 strains(7 kinds of CRO) were isolated from 102 patients, the most common of which was carbapenem-resistant Acinetobacter baumannii(CRAB). Patients were mainly located in neurosurgery, intensive care units(ICUs), and emergency ICUs. The antimicrobial resistance of different CRO pathogens was different in different degrees. The clinical effective rates of MEM group and TCG group were 80.85% and 86.49%, respectively, and the clinical effective rates of other groups were 100.00%.The total effective rate of all patients was 86.27%(88/102). In IPM group, only calcitonin decreased, and other inflammatory indicators were increased, while the other inflammatory indicators were decreased in different degrees.Conclusion: In these CRO isolated, the priority pathogen was CRAB, which was highly drug resistant to carbapenems;CRKP and CREC were resistant to IPM. In effectiveness of drug treatment, FEP group was better outcome, IPM did not improve the inflammatory indicators well.