非MDRO型CRPA临床分布特点及分层防控模式探讨

Clinical distribution of non-MDRO CRPA and stratified prevention and control mode

目的分析非多药耐药菌(Non-MDRO)型耐碳青霉烯类铜绿假单胞菌(CRPA)的临床分布特点,并提出其分层防控模式的建议.方法选择南京医科大学第一附属医院2020年1月-2022年6月临床标本中分离的CRPA、耐碳青霉烯类肠杆菌目细菌(CRE)、耐碳青霉烯类鲍氏不动杆菌(CRAB)为研究对象,根据MDRO定义,将其分别分为Non-MDRO组和多药耐药菌(MDRO)组,对比分析Non-MDRO组比例.分析Non-MDRO组CRPA临床分布、影响因素以及耐药性特点.结果医院感染重点监测的MDRO,针对铜绿假单胞菌(PA),2015年之前均为多药耐药铜绿假单胞菌(MDR-PA),2015年之后则都是CRPA;CRPA中Non-MDRO占比62.15%(770/1239),CRE和CRAB中Non-MDRO占比则分别为0.51%(9/1758)和0.91%(21/2308);Logistic多因素分析结果显示年龄和病区分布是Non-MDRO型CRPA的影响因素(P<0.05);CRPA中Non-MDRO组耐药率低于MDRO组(均P<0.05),其中Non-MDRO组除了对碳青霉烯类药物耐药率较高外,其余抗菌药物耐药率均低于20%.结论非MDRO型CRPA基数较大,危害较小,且占据一定的防控资源,建议根据情况对CRPA进行分层防控管理,即耐药菌并不多见、防控资源宽松的医疗机构可以将CRPA全部纳入常规重点监测菌,而对于部分耐药菌泛滥、防控资源紧张的大型三甲医院,则可以将重点监测菌中的CRPA更改为MDR-PA或难治型耐药菌(DTR)-PA.

OBJECTIVE To investigate the clinical distribution of non-multidrug-resistant organism(Non-MDRO)carbapenem-resistant Pseudomonas aeruginosa(CRPA)and put forward the stratified prevention and control mode.METHODS The CRPA,carbapenem-resistant Enterobacteriaceae(CRE)and carbapenem-resistant Acinetobacter baumanni(CRAB)strains that were isolated from clinical specimens in the First Affiliated Hospital of Nanjing Medical University from Jan 2020 to Jun 2022 were recruited as the research subjects and were divided into the non-MDRO group and the MDRO group according to the definition of MDRO.The proportions of the non-MDRO group were compared and analyzed.The clinical distribution,influencing factors and drug resistance of the non-MDRO CRPA were observed.RESULTS Among the MDROs under the key monitoring of nosocomial infection,all of the P.aeruginosa strains were multidrug-resistant P.aeruginosa(MDR-PA)before 2015 but were CRPA after 2015.Non-MDROs accounted for 62.15%(770/1239)among the CRPA strains,0.51%(9/1758)among CRE strains,0.91%(21/2308)among CRAB strains.The result of multivariate logistic analysis showed that age and ward distribution were the influencing factors for the non-MDRO CRPA(P<0.05).Among the CRPA strains,the drug resistance rate of the non-MDRO group was lower than that of the MDRO group(all P<0.05);the drug resistance rates of the non-MDRO CRPA strains were less than 20%to all of the antibiotics except for carbapenems.CONCLUSION The non-MDRO CRPA is characterized by large base,less harm and occupies certain prevention and control resource.It is suggested to conduct hierarchical prevention and control management of CRPA according to the situation,that is,the medical institutions with less common drug-resistant bacteria and loose prevention and control resources can include all of the CRPA strains into routine key monitoring,while the large scale three-A hospitals with some inundant drug-resistant bacteria and tight prevention and control resources can alter the CRPA under the key monitoring into MDR-PA or refractory drug-resistant(DTR)-PA.