2020-2022年某三甲妇产科医院多药耐药菌的流行病学及耐药性

Epidemiological characteristics and drug resistance of multidrug-resistant organisms in a three-A obstetrics and gynecology hospital from 2020 to 2022

目的探讨妇产科患者分离的多药耐药菌(MDRO)的临床分布特点及耐药性,为医院制定有效的防控干预措施和临床合理用药提供依据。方法采用回顾性分析方法,收集2020年1月-2022年12月复旦大学附属妇产科医院住院患者分离的MDRO菌株,分析MDRO临床感染情况、分布科室、标本来源及耐药性。结果临床共分离5257株细菌,其中1308株MDRO,来自1168例患者,MDRO检出率为24.88%;其中59株为耐甲氧西林金黄色葡萄球菌(MRSA)、1143株为产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌、91株产ESBLs的肺炎克雷伯菌、9株碳青霉烯耐药的大肠埃希菌(CREC)、5株碳青霉烯耐药的肺炎克雷伯菌(CRKP)和1株碳青霉烯耐药的鲍氏不动杆菌(CRAB),未检出耐万古霉素的肠球菌(VRE)和碳青霉烯耐药的铜绿假单胞菌(CRPA);检出MDRO患者,科室分布为:产科(15.24%),妇科(82.96%),新生儿科(1.71%),乳腺科(0.09%);标本来源主要是尿液,分离409株(31.27%),其次是阴道分泌物和宫颈分泌物,分别分离386株(29.51%)、145株(11.09%);1308株MDRO,经判定分离自584例次(44.65%)的医院感染患者,184例次(14.07%)的社区感染患者和540例次(41.28%)的定植患者;产ESBLs的大肠埃希菌和肺炎克雷伯菌除对碳青霉烯类、哌拉西林/他唑巴坦、头孢替坦和阿米卡星等药物耐药率较低外,对其他抗菌药物耐药较严重;MRSA对万古霉素、替加环素、利奈唑胺、呋喃妥因和奎奴普丁/达福普汀均敏感,对磺胺甲噁唑/甲氧嘧啶、利福平、莫西沙星等耐药率较低。结论妇产科医院CRE检出率不高,产ESBLs的大肠埃希菌和肺炎克雷伯菌是MDRO的主要类型,主要分离自妇科肿瘤患者。可通过对目标患者入院的主动筛查,强化感染防控和抗菌药物的临床管理。

OBJECTIVE To explore the clinical distribution and drug resistance of multidrug-resistant organisms(MDROs)from the patients of obstetrics and gynecology department so as to provide bases for formulating effective intervention measures for prevention and control and reasonable clinical use of antibiotics.METHODS By means of retrospective analysis,the isolated MDROs strains were collected from the patients who were hospitalized in the Obstetrics and Gynecology Hospital of Fudan University from Jan 2020 to Dec 2022.The prevalence of MDROs infections,distribution in departments,specimen sources and drug resistance were observed.RESULTS Totally 5257 strains of bacteria were isolated,1308 of which were MDROs and were isolated from 1168 patients,and the isolation rate of MDROs was 24.88%.There were 59 strains of methicillin-resistant Staphylococcus aureus(MRSA),1143 strains of extended-spectrumβ-lactamases(ESBLs)-producing Escherichia coli,91 strains of ESBLs-producing Klebsiella pneumoniae,9 strains of carbapenem-resistant E.coli(CREC),5 strains of carbapenem-resistant K.pneumoniae(CRKP)and 1 strain of carbapenem-resistant Acinetobacter baumannii(CRAB).No strains of vancomycin-resistant Enterococcus(VRE)and carbapenem-resistant P.aeruginosa(CPA)were detected.Among the patients from whom the MDROs were isolated,15.24%were from obstetrics department,82.96%from gynecology department,1.71%from neonatology department,0.09%from breast department.Among specimens sources,there were 409(31.27%)strains that were isolated from urine,386(29.51%)strains that were isolated from vaginal secretion specimens and 145(11.09%)strains that were isolated from cervical secretions.The 1308 strains of MDROs were isolated from 584(44.65%)case-times of patients with nosocomial infection,184(14.07%)case-times of patients with community-acquired infection and 540(41.28%)case-times of patients with colonization.The drug resistance rates of the ESBLs-producing E.coli and K.pneumoniae strains to carbapenems,piperacillin-tazobactam,cefotetan and amikacin were low,while the strains were highly resistant to other antibiotics.The MRSA strains were sensitive to vancomycin,tigecycline,linezolid,nitrofurantoin and quinupristin-dalfopristin,and the drug resistance rates to sulfamethoxazole-methoxazine,rifampicin and moxifloxacin were low.CONCLUSION The isolation rate of CRE is not high in the obstetrics and gynecology hospital.The ESBLs-producing E.coli and K.pneumoniae are dominant among the MDROs,most of which are isolated from the patients with gynecologic tumors.It is necessary for the hospital to carry out active screening of the enrolled target patients and intensify the prevention and control of the infections as well as the clinical management of antibiotics.