2020-2023年某院非重症监护病房多重耐药菌感染临床分布及耐药性分析  

Clinical distribution and antibiotic resistance analysis of multidrug-resistant organism infections in a non-intensive care unit of a hospital from 2020 to 2023

作　　者：杜凤英 刘一凡 Du Fengying;Liu Yifan(Department of Infection Management,Suqian First Hospital,Jiangsu Provincial(Suqian)Hospital,Suqian 223800,Jiangsu Province,China;Department of Rehabilitation Medicine,Suqian First Hospital,Jiangsu Provincial(Suqian)Hospital,Suqian 223800,Jiangsu Province,China)

机构地区：[1]江苏省人民医院宿迁医院,宿迁市第一人民医院感染管理处,宿迁223800 [2]江苏省人民医院宿迁医院,宿迁市第一人民医院康复医学科,宿迁223800

出　　处：《中国基层医药》2025年第3期364-370,共7页Chinese Journal of Primary Medicine and Pharmacy

基　　金：江苏省卫生健康委预防医学科研课题面上项目(Ym2023100)。

摘　　要：目的分析江苏省人民医院宿迁医院(宿迁市第一人民医院)非重症监护病房(ICU)多重耐药菌(MDRO)感染临床分布和耐药性,为有效落实MDRO感染防控提供依据。方法通过杏林院感实时监测系统,选取江苏省人民医院宿迁医院(宿迁市第一人民医院)2020年1月至2023年12月非ICU住院患者分离出520株MDRO感染菌株为研究对象,依据来源将其分为院内感染和院外感染两类,分析MDRO感染临床分布特点及对常用抗菌药物耐药率。结果连续4年非ICU科室MDRO平均检出率13.60%(782/5750);其中,甲氧西林耐药金黄色葡萄球菌(MRSA)、碳青霉烯类耐药鲍曼不动杆菌(CRAB)、碳青霉烯类耐药铜绿假单胞菌(CRPA)、碳青霉烯类耐药肠杆菌目细菌(CRE)检出率依次为46.49%(424/912)、43.81%(85/194)、18.61%(177/951)、2.60%(96/3693)。感染的MDRO以MRSA(54.23%,282/520)和CRPA(28.65%,149/520)为主。院内感染占13.65%(71/520),院外感染占86.35%(449/520)。感染前三位科室为呼吸科(22.31%)、儿科(15.19%)和中医烧伤科(7.88%),均以院外感染为主;不同科室MDRO感染占比差异有统计学意义(P<0.05)。标本来源中痰液占比最高(59.81%),其次创面分泌物(20.77%);痰液在院外感染占比63.25%,高于院内感染38.03%(χ^(2)=16.23,P<0.05);感染部位以下呼吸道院外感染为主。药敏结果显示,CRAB对青霉素类、碳青霉烯类及多数头孢菌素类100%耐药,CRPA对青霉素、复方甲基异噁唑等100%耐药,对其他药物耐药率低于CRAB和CRKP;MRSA对青霉素、头孢西丁等100%耐药,对替加环素、利奈唑胺等耐药率为0。结论本院非ICU科室MDRO感染86.35%来自院外,以MRSA和CRPA为主,不同科室MDRO感染占比差异大,且碳青霉烯类药物耐药形势严峻,感染防控部门应根据分布特点实施精准防控。Objective To analyze the clinical distribution and antibiotic resistance of multidrug-resistant organism(MDRO)infections in the non-intensive care unit(ICU)of Jiangsu Provincial(Suqian)Hospital(Suqian First Hospital),providing a basis for effective implementation of infection prevention and control measures.Methods Using the real-time monitoring system for hospital infections,this study selected 520 strains of MDROs isolated from non-ICU hospitalized patients at Jiangsu Provincial(Suqian)Hospital(Suqian First Hospital)from January 2020 to December 2023 for analysis.Based on their origin,these strains were categorized into two groups:hospital-acquired infections and community-acquired infections.The clinical distribution characteristics of MDRO infections and their resistance rates to commonly used antimicrobial agents were analyzed.Results The average detection rate of MDRO in non-ICU over 4 consecutive years was 13.60%(782/5750).The detection rates for methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Acinetobacter baumannii(CRAB),carbapenem-resistant Pseudomonas aeruginosa(CRPA),and carbapenem-resistant Enterobacteriaceae were 46.49%(424/912),43.81%(85/194),18.61%(177/951),and 2.60%(96/3693),respectively.The predominant MDROs identified were MRSA(54.23%,282/520)and CRPA(28.65%,149/520).Hospital-acquired infections accounted for 13.65%(71/520),while community-acquired infections comprised 86.35%(449/520).The three departments with the highest infection rates were the Department of Respiratory(22.31%),the Department of Pediatrics(15.19%),and the Department of Traditional Chinese Medicine and Burn(7.88%).All of these departments were primarily associated with community-acquired infections.Statistically significant differences were observed in the composition of MDRO infections among different departments(P<0.05).The largest proportion of specimens was obtained from sputum(59.81%),followed by wound secretions(20.77%).Sputum samples exhibited a higher proportion in community-acquired infections

关 键 词：细菌 抗药性 多药 交叉感染 感染控制 微生物敏感性试验 耐甲氧西林金黄色葡萄球菌 铜绿假单胞菌 

分 类 号：R44[医药卫生—诊断学]