| 何怡蓓,王文博,谭积善,王 琴,刘 媛.成都某三甲医院多重耐药菌的临床分布特点及耐药性分析[J].,2022,(3):500-505 |
| 成都某三甲医院多重耐药菌的临床分布特点及耐药性分析 |
| Clinical Distribution Characteristics and Drug Resistance Analysis of Multi-Drug Resistant Bacteria in a Top Three Hospital in Chengdu |
| 投稿时间：2021-05-16 修订日期：2021-06-11 |
| DOI：10.13241/j.cnki.pmb.2022.03.021 |
| 中文关键词: 多重耐药菌 分布 耐药性 抗生素 |
| 英文关键词: Multidrug-resistant organism Distribution Drug resistance Antibiotics |
| 基金项目:四川省科技计划重点研发项目（2019YFS0367）；军队后勤科研项目（CLB18J044） |
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| 中文摘要: |
| 摘要 目的：探讨我院分离多重耐药菌（MDRO）的临床分布及耐药变化，为临床抗菌药物的合理使用提供依据。方法：回顾性分析我院2019年1月～2019年12月住院患者送检标本分离的病原菌，对MDRO分布及其耐药性进行统计分析。结果：我院住院患者共分离出病原菌4399株，MDRO 459株，MDRO检出率为10.43%。MDRO前5位分别是碳青霉烯类耐药铜绿假单胞菌（CR-PAE，125株，占27.23%）、碳青霉烯类耐药鲍曼不动杆菌（CR-ABA，123株，占26.80%）、碳青霉烯类耐药肺炎克雷伯菌（CR-KPN，118株，占25.71%）、耐甲氧西林金黄色葡萄球菌（MRSA，74株，占16.12%）和碳青霉烯类耐药肠杆科细菌（CRE，13株，占2.83%）。在标本类型上，痰液中MDRO占所有MDRO分离株的60.57%，其次为尿液、肺泡灌洗液、分泌物和血液标本。MDRO分离株占前4位的科室分别为重症医学科、神经外科、康复医学科和干部病房。在耐药性方面，CR-ABA和CR-KPN是我院耐药最严重的菌株。CR-ABA对头孢他啶、头孢曲松和头孢吡肟、氟喹诺酮类药物（环丙沙星）、氨基糖苷类（庆大霉素和妥布霉素）均显示出较高的耐药性，为85.00%以上；对碳青霉烯类药物（亚胺培南）的耐药率在99.00%以上，替加环素对该耐药菌的敏感性较高。CR-KPN对复方新诺明、氨曲南、庆大霉素、喹诺酮类（环丙沙星和左氧氟沙星）、头孢烯类（头孢唑啉、头孢曲松、头孢西丁、头孢吡肟、头孢他啶）、β-内酰胺类与酶抑制剂复合物（氨苄西林/舒巴坦、阿莫西林/克拉维酸和哌拉西林/他唑巴坦）及碳青霉烯类抗菌药物（厄他培南和亚胺培南）的耐药率均在90.00%以上。结论：我院MDRO检出率较高，应加强MDRO耐药性监测，及时向临床医师反馈，建立沟通协作机制，促进合理选用抗菌药物，防止MDRO的感染和蔓延。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the clinical distribution and drug resistance of multidrug-resistant organism (MDRO) isolated in our hospital, and to provide reference for clinical rational use of antibiotics. Methods: The pathogens isolated from the samples of inpatients in our hospital from January 2019 to December 2019 were retrospectively analyzed, and the distribution and drug resistance of MDRO were statistically analyzed. Results: 4399 strains of pathogens were isolated in our hospital, 459 strains of MDRO, the detection rate of MDRO was 10.43%. The top 5 MDRO were carbapenem resistant Pseudomonas aeruginosa (CR-PAE, 125 strains, accounting for 27.23%), carbapenem resistant Acinetobacter baumannii (CR-ABA, 123 strains, accounting for 26.80%), carbapenem resistant Klebsiella pneumoniae (CR-KPN, 118 strains, accounting for 25.71%), methicillin-resistant Staphylococcus aureus (MRSA, 74 strains, accounting for 16.12%) and carbapenem resistant Enterobacteriaceae (CRE, 13 strains, accounting for 2.83%). In terms of specimen types, MDRO accounted for 60.57% of all MDRO isolates in sputum, followed by urine, alveolar lavage fluid, secretions and blood samples. The top four departments of MDRO isolates were ICU, neurosurgery department, rehabilitation medicine department and cadre ward. In terms of drug resistance, CR-ABA and CR-KPN were the most serious drug-resistant strains in our hospital. CR-ABA showed high resistance to ceftazidime, ceftriaxone and cefepime, fluoroquinolones (ciprofloxacin), aminoglycosides (gentamicin and tobramycin), which was more than 85.00%. The drug resistance rate of carbapenem (imipenem) was more than 99.00%, and the sensitivity of tigecycline to the resistant bacteria was higher. CR-KPN to compound sulfamethoxazole, aztreonam, gentamycin, quinolone cefepime (ciprofloxacin and levofloxacin), cephalosporins alkene (cefazolin, ceftriaxone, cefoxitin, cefepime, ceftazidime), β-lactam and enzyme inhibitors compounds (ampicillin/sulbactam, amoxicillin/clavulanic acid and piperacillin/tazobactam) and penicillium carbon alkene antimicrobial agents (ertapenem and imipenem) had drug resistance rates above 90.00%. Conclusion: The detection rate of MDRO in our hospital is high. We should strengthen the MDRO drug resistance monitoring, timely feedback to clinicians, establish a communication and cooperation mechanism, and promote the rational use of antibiotics to prevent the infection and spread of MDRO. |
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