药敏结果“中介”是否纳入“耐药”统计对多药耐药菌监测数据的影响

Impact of the inclusion of"intermediaries"of the drug sensitivity results in"drug resistance"statistics on the MDRO surveillance data

目的探讨药敏结果“中介”是否纳入“耐药”统计对多药耐药菌(MDRO)监测数据的影响。方法选择南京医科大学第一附属医院2020年1月-2022年6月微生物送检标本中分离出的医院重点监测MDRO,分别将“中介”纳入耐药和“中介”不纳入耐药统计,对比分析两种情况下MDRO检出率、MDRO感染例次发生率、感染构成比。结果国内不同指南和共识的MDRO定义中,对于中介是否纳入耐药统计存在差异;参与调研的20所医疗机构,15所判定MDRO时将药敏结果中介纳入耐药统计,5所判定MDRO时未将药敏结果中介纳入耐药统计;中介纳入和不纳入耐药的情况下,CRKP、CRECO、CRAB、MRSA的检出率差异无统计学意义,中介纳入耐药时的CRPA检出率(42.45%)高于中介不纳入耐药时检出率(34.17%)(P<0.001);中介纳入和不纳入耐药的情况下,CRKP、CRECO、CRAB、MRSA的感染例次发生率差异无统计学意义,中介纳入耐药时的CRPA感染例次率(0.26%)高于中介不纳入耐药时检出率(0.22%)(P<0.001);中介纳入和不纳入耐药的情况下,CRKP、CRECO、CRAB、CRPA、MRSA的感染构成比差异无统计学意义。结论MDRO判定时,中介纳入和不纳入耐药统计的情况下,CRPA检出率、CRPA感染例次发生率差异显著。建议相关部门统一MDRO监测标准,进一步提升数据监测的同质化水平。

OBJECTIVE To investigate the impact of the inclusion of"intermediary"drug susceptibility results in"drug resistance"statistics on MDRO surveillance data.METHODS The MDRO isolated from the microbial specimens sent to the First Affiliated Hospital of Nanjing Medical University from Jan.2020 to Jun.2022 were selected for priority surveillance in the hospital,and the"intermediaries"were included in drug resistance statistics and the"intermediaries"were not included in drug resistance statistics.The detection rates of MDRO,the detection rates of MDRO infection cases,and the infection component ratios were compared and analyzed under the two conditions.RESULTS There were differences in the definitions of MDRO in different guidelines and consensus in China as to whether the intermediaries were included in drug resistance statistics.Of the 20 medical institutions that participated in the survey,15 determined MDRO to include the intermediaries in drug resistance statistics,while 5 determined MDRO to not include the intermediaries in drug resistance statistics.There was no significant difference in the detection rates of CRKP,CRECO,CRAB and MRSA between mediated inclusion and non-inclusion of resistant drugs,and the detection rate of CRPA with the inclusion of intermediaries in drug resistance(42.45%)was significantly higher than that without the inclusion of intermediaries in drug resistance(34.17%)(P<0.001).There was no significant difference in the infection rate of CRKP,CRECO,CRAB and MRSA between mediated inclusion and non-inclusion of resistant drugs,and the detection rate of CRPA infection when the intermediaries included drug resistance(0.26%)was significantly higher than that when the intermediaries did not include drug resistance(0.22%)(P<0.001).There was no significant difference in the infection composition ratio of CRKP,CRECO,CRAB,CRPA and MRSA with and without the inclusion of intermediaries in drug resistance.CONCLUSION There were significant differences in the detection rate of CRPA and the detection rate of CRPA infection cases between those with and without the inclusion of intermediaries in drug statistics in the MDRO determination.It is recommended that relevant authorities unify MDRO surveillance standards to further improve the homogeneity level of data surveillance.