某综合性医院连续三年多重耐药菌感染特点分析

戴礼兰; 施明美; 张爱萍; 胡钟; 汪华学

doi:10.16766/j.cnki.issn.1674-4152.001846

某综合性医院连续三年多重耐药菌感染特点分析

doi: 10.16766/j.cnki.issn.1674-4152.001846

1.
马鞍山十七冶医院医院感染管理科，安徽马鞍山 243000
2.
蚌埠医学院第一附属医院重症医学科，安徽蚌埠 233004

基金项目:

安徽省重点研究和开发计划项目 1804h08020256

详细信息

通讯作者:
戴礼兰，E-mail：2639830979@qq.com

中图分类号: R37 R969
计量
- 文章访问数: 235
- HTML全文浏览量: 139
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2020-05-11
- 网络出版日期: 2022-02-19

Characteristics of multidrug-resistant organism infections in a hospital for three consecutive years

1.
Department of Nosocomial Infection Management, the Hospital of China Seventeenth Metallurgical Group Co., Ltd., Ma'anshan, Anhui 243000, China

摘要

摘要: 目的了解安徽省马鞍山十七冶医院2016年1月—2018年12月的多重耐药菌检出及分布情况。方法回顾性分析安徽省马鞍山十七冶医院2016年1月—2018年12月的临床送检标本中分离的多重耐药菌(MDROs)检测资料。结果 2016—2018年间分别检出MDROs 314株、420株、359株，MDROs分离率为28.31%、35.35%、30.95%，差异有统计学意义(P < 0.05)。2017年及2018年分离出的病原菌中，MDROs所占比例均超过30.00%。2016—2018年产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌检出率分别为33.90%、67.54%、40.98%(P < 0.05)；耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为20.51%、19.09%、38.53%(P < 0.05)；多重耐药鲍曼不动杆菌检出率分别为68.42%、46.15%、45.24%(P < 0.05)，呈逐年下降趋势；耐碳青霉烯类肺炎克雷伯菌检出率分别为0.00%、5.26%、9.84%(P < 0.05)，呈逐年上升趋势。MDROs检出构成比最多的科室为内科，其次为ICU。其中，泌尿外科MDROs检出构成比分别为9.24%、9.76%、6.41%(P < 0.05)。脑外科MDROs检出构成比分别为1.59%、1.46%、5.57%(P < 0.05)。MDROs检出最多的标本类型依次为痰液、尿液及其他。结论 MDROs检出率呈总体上升，尤其是耐碳青霉烯类肺炎克雷伯菌的分离率正逐年增加。应加强对MDRO感染的预防与控制管理，促进临床合理使用抗菌药物。
- 多重耐药菌 /
- 耐药性 /
- 趋势
Abstract: Objective To explore the detection and distribution of multi-drug resistant organism (MDRO) in the Hospital of China Seventeenth Metallurgical Group Co., Ltd. Methods The monitoring data for MDROs isolated from clinical thesamples submitted by the hospital of China Seventeenth Metallurgical Group Co., Ltd. from 2016 to 2018 were analyzed retrospectively. Results From 2016 to 2018, 314 strains, 420 strains and 359 strains of MDROs were detected. The isolation rate of MDROs were 28.31%, 35.35% and 30.95%, with statistically significant difference (P < 0.05). MDROs accounted for more than 30.00% of the isolated pathogens in both 2017 and 2018. The positive rates of klebsiella pneumoniae producing ESBLs were 33.90%, 67.54% and 40.98% in 2016, 2017 and 2018, respectively (P < 0.05). The detection rates of Methicillin-resistant Staphylococcus aureus (MRSA) were 20.51%, 19.09% and 38.53% in 2016, 2017 and 2018 respectively (P < 0.05). The detection rates of Acinetobacter baumannii with multiple-drug resistance were 68.42%, 46.15% and 45.24% in 2016, 2017 and 2018, respectively (P < 0.05), showed a decreasing trend year by year. The detection rates of carbapenems-resistant Klebsiella pneumoniae were 0.00%, 5.26% and 9.84% in 2016, 2017 and 2018, respectively (P < 0.05), showing an increasing trend year by year. The department with the highest proportion of MDROs detection was internal medicine, followed by ICU. The composition ratio of MDROs in urology were 9.24%, 9.76% and 6.41%, respectively (P < 0.05). The composition ratio in brain surgery were 1.59%, 1.46% and 5.57%, respectively (P < 0.05). The most common types of specimens with high detection rates of MDROs were sputum, urine, and others. Conclusion The detection rate of MDROs showed an overall increase, especially the isolation rate of carbapenems-resistant Klebsiella pneumoniae was increasing year by year. The prevention, control and management of MDROs infection should be strengthened to promote the rational use of antibiotics in clinical practice.
- Multi-drug resistant organisms /
- Drug resistance /
- Trend

HTML全文

表 1 2016—2018年多重耐药菌检出情况

年份	病原菌	多重耐药菌 [株(%)]	χ²值	P值
2016年	1 109	314(28.31)	13.508	0.001
2017年	1 188	420(35.35)
2018年	1 160	359(30.95)

下载: 导出CSV

表 2 2016—2018年常见多重耐药菌检出情况比较

菌名	2016年		2017年		2018年		χ²值	P值
菌名	菌株数(株)	检出率(%)	菌株数(株)	检出率(%)	菌株数(株)	检出率(%)	χ²值	P值
产超广谱β-内酰胺酶大肠埃希菌	114/171	66.67	124/178	69.66	125/173	72.25	1.270	0.530
产超广谱β-内酰胺酶肺炎克雷伯菌	40/118	33.90	77/114	67.54	50/122	40.98	29.203	< 0.001
多重耐药铜绿假单胞菌	19/104	18.27	24/110	21.82	23/131	17.56	0.773	0.679
耐甲氧西林金黄色葡萄球菌	16/78	20.51	21/110	19.09	42/109	38.53	12.606	0.002
耐万古肠球菌	0/26	0.00	0/64	0.00	0/42	0.00
多重耐药鲍曼不动杆菌	39/57	68.42	18/39	46.15	19/42	45.24	7.000	0.030
耐碳青霉烯类肺炎克雷伯菌	0/92	0.00	6/114	5.26	12/122	9.84	10.008	0.007
耐碳青霉烯类大肠埃希菌	1/171	0.58	2/178	1.12	3/173	1.73	0.963	0.618

下载: 导出CSV

表 3 多重耐药菌主要科室分布[株(%)]

科室	2016年	2017年	2018年	χ²值	P值
ICU	64(20.38)	77(18.78)	90(25.07)	5.419	0.067
内科	114(36.31)	130(31.71)	104(28.97)	4.717	0.095
普外科	28(8.92)	52(12.68)	35(9.75)	2.628	0.269
儿科	24(7.64)	44(10.73)	29(8.08)	2.203	0.332
妇产科	11(3.50)	20(4.88)	17(4.74)	0.056	0.972
肿瘤科	15(4.78)	14(3.41)	18(5.01)	1.572	0.456
老年病科	10(3.18)	19(2.20)	9(2.50)	2.458	0.293
泌尿外科	29(9.24)	40(9.76)	23(6.41)	7.473	0.024
骨科	14(4.46)	18(4.39)	14(3.90)	0.242	0.886
脑外科	5(1.59)	6(1.46)	20(5.57)	14.526	0.001
合计	314(100.00)	420(100.00)	359(100.00)

下载: 导出CSV

表 4 某医院2016—2018年多重耐药菌标本来源[株(%)]

标本名称	2016年	2017年	2018年	χ²值	P值
痰液	98(31.21)	130(30.95)	122(33.98)	0.950	0.622
尿液	82(26.11)	119(28.33)	113(31.48)	2.404	0.301
血液	33(10.51)	48(11.43)	37(10.31)	0.291	0.865
咽拭子	26(8.28)	33(7.86)	12(3.34)	8.804	0.012
伤口拭子	8(2.55)	6(1.43)	3(0.84)	3.236	0.198
引流液	6(1.91)	13(3.10)	12(3.34)	1.412	0.494
其他	61(19.43)	71(16.90)	60(16.71)	1.058	0.589
合计	314(100.00)	420(100.00)	359(100.00)

下载: 导出CSV

参考文献(20)

[1]	陈美恋, 王守军, 匡季秋, 等. 某院2016—2018年ICU多重耐药菌医院感染特点分析[J]. 中国护理管理, 2019, 19(12): 1877-1880. doi: 10.3969/j.issn.1672-1756.2019.12.023
[2]	FERSTL P G, MVLLER M, FILMANN N, et al. Noninvasive screening identifies patients at risk for spontaneous bacterial peritonitis caused by multidrug-resistant organisms[J]. Infect Drug Resist, 2018, 11(2): 2047-2061. http://www.researchgate.net/publication/328690367_Noninvasive_screening_identifies_patients_at_risk_for_spontaneous_bacterial_peritonitis_caused_by_multidrug-resistant_organisms/download
[3]	迟星云, 朱晓莉, 王虹, 等. 重症监护病房多重耐药菌检出及药物敏感性[J]. 中华医院感染学杂志, 2019, 29(24): 3729-3733. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201924013.htm
[4]	洪燕, 郭海萍, 陈金连, 等. 某院恶性肿瘤患者多重耐药菌感染监测及危险因素分析[J]. 中华全科医学, 2020, 18(2): 314-317. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202002041.htm
[5]	林秀娟, 林红燕, 钟韵. 某三甲医院2014—2016年多重耐药菌感染趋势变迁[J]. 广东医学, 2018, 39(1): 107-110. doi: 10.3969/j.issn.1001-9448.2018.01.029
[6]	EFIMENKO T A, MEVAALANICHEVA I A, VASIL'EVA B F, et al. Antibiotic activity of bacterial endobionts of basidiomycete fruit bodies[J]. Microbiology, 2016, 85(6): 752-758. doi: 10.1134/S0026261716060084
[7]	刘卫平, 焦月英, 海云婷, 等. 某医院多重耐药菌感染分布趋势与耐药性分析[J]. 中国消毒学杂志, 2018, 35(12): 931-933, 936. doi: 10.11726/j.issn.1001-7658.2018.12.015
[8]	胡付品, 郭燕朱, 朱德妹, 等. 2017年CHINET中国细菌耐药性监测[J]. 中国感染与化疗杂志, 2018, 18(3): 241-251. https://www.cnki.com.cn/Article/CJFDTOTAL-KGHL201803001.htm
[9]	QUAN J, ZHAO D, LIU L, et al. High prevalence of ESBL-producing Escherichia coli and Klebsiella pneumoniae in communityonset bloodstream infections in China[J]. J Antimicrob Chemother, 2017, 72(6): 273-280. http://www.onacademic.com/detail/journal_1000039598429010_80eb.html
[10]	崔秀格, 吴忠伟, 王珊珊, 等. 耐碳青霉烯类抗菌药物肠杆菌科细菌的分离及耐药性分析[J]. 中国医药, 2019, 14(9): 1410-1414. doi: 10.3760/j.issn.1673-4777.2019.09.032
[11]	HU F P, GUO Y, ZHU D M, et al. Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance, 2005-2014[J]. Clin Microbiol Infect, 2016, 22(Suppl 1): s9-s14.
[12]	伊贝拜汗·买卖提, 章波, 王海叶, 等. 某三级综合医院肠杆菌科细菌分布及耐药性分析[J]. 中国消毒学杂志, 2019, 9. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXD201909013.htm
[13]	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): 1720-1724. doi: 10.3969/j.issn.1007-4287.2018.10.013
[14]	STRICH J R, PALMORE T N. Preventing transmission of multidrug-resistant pathogens in the intensive care unit[J]. Infect Dis Clin North Am, 2017, 31(3): 535-550. doi: 10.1016/j.idc.2017.05.010
[15]	CHANG J B, WU H, WANG H, et al. Prevalence and antibiotic resistance of bacteria isolated from the cerebrospinal fluid of neurosurgical patients at Peking Union Medical College Hospital[J]. Antimicrob Resist Infect Control, 2018, 7(1): 40-41. doi: 10.1186/s13756-018-0332-2
[16]	何雨峰, 李宁侠, 段金秋, 等. 急性脑卒中患者下呼吸道多重耐药菌感染的危险因素分析[J]. 海南医学, 2018, 29(22): 3135-3139. doi: 10.3969/j.issn.1003-6350.2018.22.009
[17]	TSENG W P, CHEN Y C, CHEN S Y, et al. Risk for subsequent infection and mortality after hospitalization among patients with multidrug-resistant gram-negative bacteria colonization or infection[J]. Antimicrob Resist Infect Control, 2018, 7(93): 121-125. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069822/
[18]	许莉, 王仁媛, 陈贝贝, 等. 新生儿重症监护病房多重耐药菌感染的危险因素及防控措施[J]. 中华全科医学, 2018, 16(8): 1314-1317. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201808027.htm
[19]	FELEKE T, ESHETIE S, DAGNEW M, et al. Multidrug-resistant bacterial isolates from patients suspected of nosocomial infections at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia[J]. BMC Res Notes, 2018, 11(2): 602. http://www.researchgate.net/publication/327133129_Multidrug-resistant_bacterial_isolates_from_patients_suspected_of_nosocomial_infections_at_the_University_of_Gondar_Comprehensive_Specialized_Hospital_Northwest_Ethiopia/download
[20]	李花花, 白黎. 感染科多重耐药菌株感染分布及耐药情况的调查分析[J]. 护理实践与研究, 2020, 17(11): 15-17. doi: 10.3969/j.issn.1672-9676.2020.11.005