某三甲医院临床分离多药耐药菌流行病学分布及耐药性分析
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摘要
目的分析某三甲医院临床分离多药耐药菌的分布情况及耐药特点,为多药耐药菌的预防和治疗提供临床依据。方法采用回顾性分析方法,收集2015年1月-2017年12月医院排名前五位多药耐药菌患者的临床资料,了解医院多药耐药菌种类、科室分布,行细菌培养和耐药性分析。结果临床分离1 086株多药耐药菌,排名前五位的多药耐药菌分别为:MDR-AB、MRSA、MDR-PA、耐碳青霉烯类肺炎克雷伯菌、耐碳青霉烯类大肠埃希菌。多药耐药菌检出科室分布以ICU为主(34.99%);标本种类以痰液为主(73.48%)。药敏结果显示:MDR-AB对大多数抗菌药物耐药率均在90%以上,替加环素最低11.5%;MRSA对万古霉素、利奈唑胺、替考拉宁、奎奴普丁/达福普汀、呋喃妥因耐药率为0;MDR-PA对检测的15种抗菌药物耐药率均在65%以上;CRE包括耐碳青霉烯类的肺炎克雷伯菌和大肠埃希菌对大多数抗菌药物耐药率均很高,对阿米卡星耐药率最低,分别为23.8%和0。结论近年来医院多药耐药菌耐药率较高。
OBJECTIVE To investigate the distribution and drug resistance of clinical multidrug-resistant organisms(MDROs) in a three-A hospital so as to provide guidance for clinical prevention and treatment of MDROs. METHODS From Jan 2015 to Dec 2017, the clinical data of the patients from whom the top 5 species of MDROs were isolated were retrospectively analyzed, the species of MDROs and distribution of departments were observed, and the results of bacterial culture and drug susceptibility testing were analyzed. RESULTS Among the 1086 clinical MDROs isolates, MDR-AB, MRSA, MDR-PA, carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Escherichia coli ranked the top 5 species of MDROs. 34.99% of the MDROs were isolated from ICU, and 73.48% were isolated from sputum specimens. The result of drug susceptibility testing showed that the drug resistance rates of the MDR-AB strains to most of the antibiotics were more than 90%, the drug resistance rate to tigecycline was the lowest(11.5%); the drug resistance rates of the MRSA strains to vancomycin, linezolid, teicoplanin, quinoputin-dafopentin and macrodantin were 0; the drug resistance rates of the MDR-PA to 15 types of antibiotics were more than 65%; the CRE strains,including carbapenems-resistant Klebsiella pneumoniae and Escherichia coli, were highly resistant to most of the antibiotics(23.8%, and the drug resistance rate to amikacin was 0. CONCLUSION The drug resistance rates of the MDROs are high in recent year.
OBJECTIVE To investigate the distribution and drug resistance of clinical multidrug-resistant organisms(MDROs) in a three-A hospital so as to provide guidance for clinical prevention and treatment of MDROs. METHODS From Jan 2015 to Dec 2017, the clinical data of the patients from whom the top 5 species of MDROs were isolated were retrospectively analyzed, the species of MDROs and distribution of departments were observed, and the results of bacterial culture and drug susceptibility testing were analyzed. RESULTS Among the 1086 clinical MDROs isolates, MDR-AB, MRSA, MDR-PA, carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Escherichia coli ranked the top 5 species of MDROs. 34.99% of the MDROs were isolated from ICU, and 73.48% were isolated from sputum specimens. The result of drug susceptibility testing showed that the drug resistance rates of the MDR-AB strains to most of the antibiotics were more than 90%, the drug resistance rate to tigecycline was the lowest(11.5%); the drug resistance rates of the MRSA strains to vancomycin, linezolid, teicoplanin, quinoputin-dafopentin and macrodantin were 0; the drug resistance rates of the MDR-PA to 15 types of antibiotics were more than 65%; the CRE strains,including carbapenems-resistant Klebsiella pneumoniae and Escherichia coli, were highly resistant to most of the antibiotics(23.8%, and the drug resistance rate to amikacin was 0. CONCLUSION The drug resistance rates of the MDROs are high in recent year.
引文
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[19] 尹秀云,于农,曾利军,等.2012-2013年军事医学科学院附属医院主要病原菌分布及耐药性分析[J].军事医学,2014,38(5):365-370.
[20] 王明贵.广泛耐药革兰阴性菌感染的实验诊断、抗菌治疗及医院感染控制:中国专家共识[J].中国感染与化疗杂志,2017,17(1):82-92.
[21] Ibrahim MM,Abuelmatty AM,Mohamed GH,et al.Best tigecycline dosing for treatment of infections caused by multidrug-resistant pathogens in critically ill patients with different body weights[J].Drug Des Devel Ther,2018,12:4171-4179.
[22] Mohammadi M,Soroush S,Delfani S,et al.Distribution of class D carbapenemase and extended-spectrum β-lactamase genes among Acinetobacter baumannii isolated from burn wound and ventilator-associated pneumonia infections[J].J Clin Diagn Res,2017,11(7):DC19-DC23.
[23] 胡付品.2005-2014年CHINET中国细菌耐药性监测网5种重要临床分离菌的耐药性变迁[J].中国感染与化疗杂志,2017,17(1):93-99.
[2] Jia H,Li W,Hou T,et al.The attributable direct medical cost of healthcare-associated infection caused by multidrug resistance organisms in 68 hospitals of China[J].Biomed Res Int,2019,3:1-7.
[3] Paul M,Narendrakumar L,R Vasanthakumary A,et al.Genome sequence of a multidrug-resistant Klebsiella pneumoniae ST78 with high colistin resistance isolated from a patient in India[J].J Glob Antimicrob Resist,2019,17:187-188.
[4] Lamut A,Peterlin Masic L,Kikelj D,et al.Efflux pump inhibitors of clinically relevant multidrug-resistant bacteria[J].Med Res Rev,2019,19(2)382-402.
[5] Sosa-Hernandez O,Matias-Tellez B,Estrada-Hernandez A,et al.Incidence and costs of ventilator-associated pneumonia in the adult intensive care unit of a tertiary referral hospital in Mexico[J].Am J Infect Control,2019,pii:S0196-6553(19)30145-2.
[6] 陈美恋,贾会学,李六亿.多重耐药菌感染监测及防控现状综述[J].中国感染控制杂志,2015,14(8):571-576.
[7] Awan AB,Schiebel J,Bohm A,et al.Association of biofilm formation and cytotoxic potential with multidrug resistance in clinical isolates of Pseudomonas aeruginosa[J].EXCLI J,2019,18:79-90.
[8] Magiorakos AP,Srinivasan A,Carey RB,et al.Multidrug-resistant,extensively drug-resistant and pandrug-resistant bacteria:an international expert proposal for interim standard definitions for acquired resistance[J].Clin Microbiol Infect,2012,18(3):268-281.
[9] 胡必杰,倪语星,马小军,等.临床微生物标本规范化采集和送检中国专家共识[M].中华预防医学会医院感染控制分会,2017.
[10] 尚红,王毓三,申子瑜.全国临床检验操作规程[M]4版.北京:人民卫生出版社,2014:720-721.
[11] Wayne PA.Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing:Twenty-second Informational Supplement[S].Clinical and Laboratory Standards Institute,2013.
[12] 赵峻英,董剑,杨静,等.多重耐药菌的医院感染状况及耐药性分析[J].中国实验诊断学,2018,22(10):1720-1723.
[13] 贾莉萍,王洪江,刘欣波,等.北京某三级甲等医院多药耐药菌检出分析[J].中华医院感染学杂志,2018,28(16):2470-2473.
[14] 孙艳,邢虎.某院烧伤整形病房细菌分布情况及耐药性分析[J].中国卫生标准管理,2018,9(21):121-123.
[15] 孙艳,谭谦,聂兰军,等.江苏地区烧伤ICU鲍氏不动杆菌院内感染菌株的分布及耐药性监测[J].中华医院感染学杂志,2018,28(18):2736-2739.
[16] Junie LM,Jeican II,Matros L,et al.Molecular epidemiology of the community-associated methicillin-resistant Staphylococcus aureus clones:a synthetic review[J].Clujul Med,2018,91(1):7-11.
[17] Holden MT,Hsu LY,Kurt K,et al.A genomic portrait of the emergence,evolution,and global spread of a methicillin-resistant Staphylococcus aureus pandemic[J].Genome Res,2013,23(4):653-664.
[18] 黄志坚,倪玉娥,唐炳娣.重症监护病房MRSA感染的危险因素[J].中国感染控制杂志,2018,17(12):1103-1106.
[19] 尹秀云,于农,曾利军,等.2012-2013年军事医学科学院附属医院主要病原菌分布及耐药性分析[J].军事医学,2014,38(5):365-370.
[20] 王明贵.广泛耐药革兰阴性菌感染的实验诊断、抗菌治疗及医院感染控制:中国专家共识[J].中国感染与化疗杂志,2017,17(1):82-92.
[21] Ibrahim MM,Abuelmatty AM,Mohamed GH,et al.Best tigecycline dosing for treatment of infections caused by multidrug-resistant pathogens in critically ill patients with different body weights[J].Drug Des Devel Ther,2018,12:4171-4179.
[22] Mohammadi M,Soroush S,Delfani S,et al.Distribution of class D carbapenemase and extended-spectrum β-lactamase genes among Acinetobacter baumannii isolated from burn wound and ventilator-associated pneumonia infections[J].J Clin Diagn Res,2017,11(7):DC19-DC23.
[23] 胡付品.2005-2014年CHINET中国细菌耐药性监测网5种重要临床分离菌的耐药性变迁[J].中国感染与化疗杂志,2017,17(1):93-99.