新型冠状病毒感染疫情暴发前后复旦大学附属闵行医院多重耐药菌监测分析

Surveillance on the multidrug-resistant bacteria before and after onset of COVID-19 pandemic in Minhang Hospital,Fudan University

目的统计分析新型冠状病毒感染疫情暴发前后复旦大学附属闵行医院多重耐药菌检出情况和耐药率变化。方法比较2017—2019年(疫情前)和2020—2022年(疫情后)两个阶段6种细菌的耐药性变化。使用WHONET 5.6软件统计细菌耐药监测数据。结果较疫情前,疫情后耐碳青霉烯类肺炎克雷伯菌检出率升高(40.1%对27.9%,P<0.01),耐碳青霉烯类大肠埃希菌检出率降低(1.9%对3.1%,P<0.05),其他耐碳青霉烯类的鲍曼不动杆菌、铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌和耐万古霉素肠球菌检出率无显著差异。疫情暴发前后,多重耐药菌均主要分离自呼吸道样本(78.4%对78.5%)。疫情后ICU多重耐药菌总检出率明显高于疫情前(53.1%对35.5%,P<0.01)。较疫情前,疫情后耐甲氧西林金黄色葡萄球菌对甲氧苄啶-磺胺甲唑的耐药率下降(3.5%对15.7%,P<0.01),粪肠球菌对青霉素G、氨苄西林和左氧氟沙星的耐药率均降低,屎肠球菌对高浓度庆大霉素的耐药率降低(39.2%对50.1%,P<0.01),大肠埃希菌对亚胺培南的耐药率降低(1.2%对2.7%,P<0.01)。铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类抗生素的耐药率基本保持稳定,疫情暴发前后无显著差异(P>0.05)。结论新型冠状病毒感染疫情暴发后耐碳青霉烯类大肠埃希菌检出率明显下降,耐碳青霉烯类的鲍曼不动杆菌和铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌有下降趋势,但耐碳青霉烯类肺炎克雷伯菌检出率和耐药率显著增加,仍需加强院感防控管理,控制多重耐药菌的传播。

Objective To analyze the changing prevalence and resistance profiles of multiple drug-resistant(MDR)bacteria in Minhang Hospital of Fudan University before and after the onset of COVID-19 pandemic.Methods The resistance profiles of 6 bacterial species were compared before(2017-2019)and after(2020-2022)the onset of COVID-19 pandemic.WHONET 5.6 software was used to statistically analyze the data of antimicrobial susceptibility testing.Results After the onset of COVID-19(2020-2022),the prevalence of carbapenem-resistant Klebsiella pneumoniae(CRKP)was significantly higher than that in the pre-pandemic period(2017-2019)(40.1%vs 27.9%,P<0.01),while the prevalence of carbapenem-resistant Escherichia coli(CREC)decreased significantly(1.9%vs 3.1%,P<0.05).The prevalences of carbapenem-resistant Acinetobacter baumannii(CRAB),carbapenem-resistant Pseudomonas aeruginosa(CRPA),methicillin-resistant Staphylococcus aureus(MRSA),and vancomycin-resistant Enterococcus(VRE)did not show significant difference before and after the onset of COVID-19 pandemic.MDR isolates were mainly isolated from respiratory tract samples either before or after COVID-19 pandemic(78.4%vs 78.5%).The prevalence of MDR in the intensive care unit(ICU)was significantly higher during the period from 2020 to 2022 compared to the pre-pandemic period(53.1%vs 35.5%,P<0.01).The resistance rate of MRSA to methoprim-sulfamethoxazole decreased from 15.7%during 2017-2019 to 3.5%during 2020-2022(P<0.01).Compared to the pre-pandemic period,the E.faecalis strains showed lower resistance rates to penicillin G,ampicillin,and levofloxacin during 2020-2022.The resistance rate of E.faecium to high-level gentamicin decreased significantly from 50.1%during 2017-2019 to 39.2%during 2020-2022(P<0.01).The resistance rate of E.coli to imipenem decreased from 2.7%to 1.2%(P<0.01),while A.baumannii and P.aeruginosa strains showed stable resistance rates to carbapenems(P>0.05).Conclusions After the onset of COVID-19 pandemic,the prevalence of CREC decreased significantly.The prevalences of CRAB,CRPA,MRSA,and VRE also showed a decreasing trend.However,the prevalence and resistance rates of CRKP significantly increased.It is necessary to strengthen hospital infection control measures to curb the spread of MDR bacteria.