2020年-2022年某医院ICU碳青霉烯耐药革兰阴性杆菌的分布特点及耐药性分析  

Distribution Characteristics and Drug Resistance Analysis of Carbapenem-Resistant Organisms in the ICU of a Hospital from 2020 to 2022

作　　者：陆丹 潘倩 周雪婷 魏望 沈艳丽 乔莉 薛魁 Lu Dan;Pan Qian;Zhou Xue-ting;Wei Wang;Shen Yan-li;Qiao Li;Xue Kui(Department of Clinical Laboratory,Pizhou People's Hospital,Xuzhou Medical University,Pizhou Jiangsu 221300)

机构地区：[1]徐州医科大学附属邳州市人民医院检验科,江苏邳州221300

出　　处：《国外医药(抗生素分册)》2024年第6期411-417,共7页World Notes on Antibiotics

基　　金：江苏省科技计划项目(Z2022056);徐州市卫健委青年医学科技创新项目(XWKYHT20220160)。

摘　　要：目的分析重症监护病房(ICU)碳青霉烯耐药革兰阴性杆菌(CRO)的分布特点、耐药性及碳青霉烯类抗菌药物使用强度(AUD),为ICU合理用药和控制细菌耐药提供依据。方法收集2020年1月—2022年12月徐州医科大学附属邳州市人民医院ICU住院患者分离的CRO菌株,使用Whonet 5.6和SPSS 27.0软件进行统计学分析。结果共收集CRO菌株260株,其中碳青霉烯耐药鲍曼不动杆菌(CRAB)163株(62.93%)、碳青霉烯耐药铜绿假单胞菌(CRPA)39株(15.06%)、碳青霉烯耐药肺炎克雷伯菌(CRKP)30株(11.58%)和碳青霉烯耐药大肠埃希菌(CREC)10株(3.85%)。三年间,CRO检出率从11.68%增加至22.69%,CRAB、CRPA、CRKP及CREC的平均检出率分别为63.67%、13.40%、4.75%和3.95%。标本来源主要为痰液(78.08%),其次为肺泡灌洗液(6.54%)、血液(3.85%)等。CRO总检出率与碳青霉烯类AUD呈强相关(r=1.00,P<0.001)。四种主要的CRO均对常见抗菌药物普遍耐药,仅对少量抗菌药物敏感,其中CRAB对替加环素、多西环素、米诺环素及黏菌素的耐药率较低,为0.61%~35.58%;CRKP和CREC未检出对替加环素耐药菌株;CRPA对常用抗菌药物的耐药率较其他三种CRO低,且对黏菌素和阿米卡星高度敏感。结论ICU检出CRO菌株耐药情况严峻,应加强医院感染防控和抗菌药物管理,以减少耐药菌的产生并控制其传播。Objective To analyze the distribution characteristics,drug resistance and antibiotics use the density of carbapenem(AUD)of carbapenem-resistant organisms(CRO)in the intensive care unit(ICU),so as to provide the basis for rational drug use and control of bacterial resistance in ICU.Methods CRO strains isolated from the ICU of Pizhou People’s Hospital Affiliated with Xuzhou Medical University from January 2020 to December 2022 were collected,and statistical analysis was performed by using Whonet 5.6 and SPSS 27.0 software.Results 30 strains(11.58%)of carbapenem-resistant Klebsiella pneumoniae(CRKP),10 strains(3.85%)of carbapenem-resistant Escherichia coli(CREC),39 strains(15.06%)of carbapenem-resistant Pseudomonas aeruginosa(CRPA),and 163 strains(62.93%)of carbapenem-resistant Acinetobacter baumannii(CRAB)were among the 260 CRO strains that were gathered.During the 3 years,the CRO detection rate increased from 11.68%to 22.69%,and the average detection rates of CRAB,CRPA,CRKP and CREC were 63.67%,13.40%,4.75%and 3.95%,respectively.The main source of samples was sputum(78.08%),followed by alveolar lavage fluid(6.54%),blood(3.85%)and so on.The total detection rate of CRO was highly positively correlated with the use intensity of carbapenems(r=1.00,P<0.001).The four major CRO were generally resistant to common antibiotics and only sensitive to a small number of antibiotics.Among them,CRAB had a low resistance rate to tigecycline,doxycycline,minocycline and colistin,ranging from 0.61%to 35.58%;no tigecycline-resistant strains were detected in CRKP and CREC;CRPA was relatively less resistant to the other three CROs,and highly sensitive to colistin and amikacin.Conclusion In summary Since the CRO strains seen in the ICU have significant drug resistance,it is important to improve nosocomial infection prevention and control as well as antimicrobial management in order to lower the growth of drug-resistant organisms and stop their spread.

关 键 词：重症监护病房 碳青霉烯耐药革兰阴性杆菌 耐药性 合理用药 

分 类 号：R978[医药卫生—药品]