上海市杨浦区老年护理院患者菌群分布及耐药性分析  

Analysis on distribution and drug resistance of bacterial flora in elderly nursing homes in Yangpu District,Shanghai

作　　者：王琳琳 赵军 张庆五 李灵筠 邹红 卜丽娜 WANG Lin-lin;ZHAO Jun;ZHANG Qing-wu;LI Ling-jun;ZOU Hong;BU li-na(Laboratory of Shanghai,Yangpu District Kongjiang Hospital,Shanghai 200093,China;Shanghai Yangpu District Hudong Elderly Care Hospital,Shanghai 200093,China)

机构地区：[1]上海市杨浦区控江医院检验科,上海200093 [2]上海市杨浦区沪东老年护理院,上海200093

出　　处：《医药论坛杂志》2023年第12期54-57,62,共5页Journal of Medical Forum

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2021-04-58)。

摘　　要：目的分析上海市杨浦区老年护理院患者菌群分布及耐药性特征。方法选取2022年1月至2022年6月在杨浦区老年护理院病房接受治疗的400例患者为研究对象。所有患者均通过肛拭子采集样本,采用梅里埃MALDI-TOF快速微生物鉴定系统分析菌群分布;同时采用梅里埃VITEK COMPACT进行药敏性分析,分析计算耐药率;通过PCR法检测常见的碳青霉烯酶基因,确定所测细菌耐药基因的基因型;根据耐药基因检测结果,经MLST方法分析其同源性。结果院内感染的患者为39例,感染率为9.75%,其中呼吸道感染17例、泌尿系统感染7例、胃肠道感染15例;共检出病原菌43株,革兰氏阴性菌33株,所占比例为76.74%,革兰阳性菌8株,所占比例为20.93%,真菌感染2例,所占比例为4.65%;肺炎克雷伯菌对氨苄西林的耐药率最高为100.0%,头孢唑林的耐药率为58.33%,亚胺培南的耐药率为8.33%;共检出12种耐药基因,分别为bla_(KPC-2)、bla_(NDM-1)、bla_(IMP-4)、bla_(OXA-48)、bla_(VIM)、bla_(DHA)、Aac(3)-Ⅱ、Aac(6)-Id、rmB、TrbC、IS26及IS903,其中blaKPC-2耐药基因携带率较高;共检出9种ST型别,分别为ST11、ST571、ST23、ST37、ST789、ST2237、ST392、ST395、ST494,其中ST11所占比例最高。结论上海市杨浦区老年护理院菌群种类多,分布广,耐药性高。应加强对老年护理院菌群的分析,积极组织健康宣教活动,严格进行院内消毒,减少院内交叉感染。Objective To analyze the distribution and drug resistance characteristics of bacterial flora in elderly nursing homes in Yangpu District,Shanghai.Methods From January 2022 to June 2022,400 patients who were treated in the Shanghai Yangpu District Hudong Elderly Care Hospital were selected as the study subjects.All patients collected samples with anal swabs,and analyzed the distribution of flora with Merier MALDI-TOF rapid microbial identification system;At the same time,Merier VITEK COMPACT was used to analyze the drug sensitivity and calculate the drug resistance rate;The common carbapenemase gene was detected by PCR to determine the genotype of the tested bacterial drug resistance gene;According to the results of drug resistance gene detection,its homology was analyzed by MLST method.Results There were 39 patients with nosocomial infection,the infection rate was 9.75%,including 17 cases of respiratory tract infection,5 cases of urinary system infection,13 cases of gastrointestinal tract infection and 4 cases of blood infection;A total of 43 pathogenic bacteria were detected,including 33 gram-negative bacteria,accounting for 76.74%,8 gram-positive bacteria,accounting for 20.93%,and 2 fungal infections,accounting for 4.65%;The highest resistance rate of Klebsiella pneumoniae to ampicillin was 100.0%,the resistance rate of cefazolin was 58.33%,and the resistance rate of imipenem was 8.33%;A total of 12 drug resistance genes were detected,including bla_(KPC-2),bla_(NDM-1),bla_(IMP-4),bla_(OXA-48),bla_(VIM),bla_(DHA),Aac(3)-Ⅱ,Aac(6)-Id,rmB,TrbC,IS26 and IS903.The carrier rate of blaKPC-2 drug resistance genes was high;A total of 9 ST types were detected,including ST11,ST571,ST23,ST37,ST789,ST2237,ST392,ST395,and ST494,of which ST11 accounted for the highest proportion.Conclusion There are many kinds of bacteria in Shanghai Yangpu District Hudong Elderly Care Hospital,with wide distribution and high drug resistance.We should strengthen the analysis of bacterial flora in elderly nursing homes,actively organize healt

关 键 词：老年护理院 菌群 分布 耐药性分析 

分 类 号：R446.1[医药卫生—诊断学]