2021-2023年某院碳青霉烯类耐药革兰阴性杆菌分布及耐药性分析

Distribution and drug resistance analysis of Carbapenem resistant Gram-negative bacteria in some hospital from 2021 to 2023

目的分析广东省第二中医院临床分离碳青霉烯类耐药革兰阴性杆菌(Carbapenem resistant Gram-negative bacilli,CR-GNB)的分布情况和耐药性特点。方法选取广东省第二中医院2021年1月1日至2023年6月30日经临床分离鉴定检测的2754株CR-GNB;使用WHONET5.6软件分析CR-GNB的分布特征及药敏检测耐药性特点。结果临床分离筛选出CR-GNB 2754株,其中,碳青霉烯类耐药肺炎克雷伯氏菌(Carbapenem resistant Klebsiella pneumoniae,CRKP)843株(30.6%),碳青霉烯类耐药鲍曼不动杆菌(Carbapenem-resistant Acinetobacter baumannii,CRAB)765株(27.8%),碳青霉烯类耐药铜绿假单胞菌(Carbapenem-resistant Pseudomonas aeruginosa,CRPA)679株(24.7%),碳青霉烯类耐药大肠埃希菌(Carbapenem-resistant Escherichia coli,CREC)203株(7.4%),其他CR-GNB 264株(9.5%)。CR-GNB主要标本来源:痰液1702株(61.8%),尿液639株(23.2%),肺泡灌洗液232株(8.4%),血液78株(2.8%),分泌物71株(2.6%)。主要科室分布:呼吸与危重症医学科病区532株(19.3%),重症医学科病区365株(13.3%),针康一区病区325株(11.8%),针康七区病区181株(6.6%)。针康病区合计分离出1330株(48.9%)。CR-GNB普遍对抗生素存在多重耐药或泛耐药,对少数药物敏感率较高;CRKP对替加环素的敏感率是100.0%;CRAB对阿米卡星、妥布霉素、米诺环素的敏感率分别是73.9%、59.0%、49.3%;CRPA对阿米卡星、妥布霉素、多黏菌素B的敏感率分别为78.1%、75.5%、46.5%;CREC对替加环素的敏感率为100.0%。结论广东省第二中医院临床分离的CR-GNB以CRKP、CRAB、CRPA和CREC为主。CR-GNB呈多重耐药或泛耐药,可选择的治疗药物有限,临床需规范抗生素的使用,同时根据CR-GNB的耐药特点制定有效可行的治疗方案,防范CR-GNB在院内感染和传播。

Objective To analyze the distribution and drug resistance characteristics of Carbapenem resistant Gram-negative bacilli(CR-GNB)isolated from Guangdong Provincial Second Hospital of Traditional Chinese Medicine.Methods From January 1,2021 to June 30,2023,2754 strains of CR-GNB were identified by clinical isolation and identification in Guangdong Provincial Second Hospital of Traditional Chinese Medicine.The WHONET5.6 software was used to analyze the distribution characteristics of CR-GNB and the characteristics of drug susceptibility detection resistance.Results A total of 2754 strains of CR-GNB were clinically isolated and screened,including 843 strains of carbapenem-resistant Klebsiella pneumoniae(CRKP),accounting for 30.6%,765 strains of Carbapenem-resistant Acinetobacter baumannii(CRAB),accounting for 27.8%,679 strains of Carbapenem-resistant Pseudomonas aeruginosa(CRPA),accounting for 24.7%,203 strains of carbapenem-resistant Escherichia coli(CREC),accounting for 7.4%,and 264 strains of other CR-GNB,accounting for 9.5%.The main sources of CR-GNB samples were sputum(1702 strains,61.8%),urine(639 strains,23.2%),alveolar lavage fluid(232 strains,8.4%),blood(78 strains,2.8%),and secretions(71 strains,2.6%).The main departments were respiratory and critical care medicine(532 strains,19.3%),intensive care medicine(365 strains,13.3%),Acupuncture Kang District 1(325 strains,11.8%),and Acupuncture Kang District 7(181 strains,6.6%).A total of 1330 strains(48.9%)were isolated from the Acupuncture Kang Districts.CR-GNB generally has multiple drug resistance or pan-resistance to antibiotics,and the sensitivity rate of a few drugs is high.The sensitivity rate of CRKP to tigacycline was 100.0%.The sensitivity rates of CRAB to amikacin,tobramycin,and minocycline were 73.9%,59.0%,and 49.3%,respectively.The sensitivity rates of CRPA to amikacin,tobramycin,and polymyxin B were 78.1%,75.5%,and 46.5%,respectively.The sensitivity rate of CREC to tigecycline was 100.0%.Conclusions The CR-GNB isolated in Guangdong Provincial Second Hospital of Traditional Chinese Medicine are mainly CRKP,CRAB,CRPA,and CREC.CR-GNB is multi-drug resistant or pan-resistant,and the available therapeutic drugs are limited.Clinical use of antibiotics should be regulated,and effective and feasible treatment plans should be formulated according to the drug resistant characteristics of CR-GNB to prevent nosocomial infection and spread of CR-GNB.