某院2016~2020年泌尿外科多重耐药病原菌分布及耐药性分析

目的了解中山大学附属第六医院泌尿外科多重耐药菌的分布特征以及耐药性,为有效控制多重耐药菌以及合理选择抗菌药物提供依据。 方法回顾性分析我院泌尿外科2016年1月1日至2020年12月31日分离的306例患者中的多重耐药菌,包括多重耐药菌数目、多重耐药菌类型、送检标本分布以及多重耐药菌药敏情况等,并结合我院2016年至2020年泌尿外科疾病综合指数（CMI）以及限定日剂量（DDD）进一步探讨。 结果2016年至2020年泌尿外科CMI分别是0.97,0.95,1.19,1.21,1.28,共检出306例多重耐药菌,各年份耐药菌数目分别是32株、53株、64株、111株、46株,检出率分别为11.1%,7.5%,10.1%,9.1%,4.2%,经比较,2020年多耐菌检出率明显降低,具有统计学意义。多重耐药菌疾病分布方面,泌尿系结石占99例（32.4%）,其次为泌尿系感染47例（15.4%）;泌尿系统肿瘤44例（14.4%）,耐药菌标本分布方面,中段尿标本268例,占87.6%,血标本14例,占4.6%。前三位多重耐药菌排名依次是大肠埃希菌223例（72.9%）,肺炎克雷伯菌43例（14.1%）,凝固酶阴性葡萄球菌19例（6.2%）。进一步耐药性分析显示,大肠埃希菌耐药率高的抗菌药物分别是头孢他啶69.10%,头孢吡肟65.00%,环丙沙星43.90%,肺炎克雷伯菌耐药率高的抗菌药物依次为头孢他啶60.50%,头孢吡肟55.80%,氨苄西林41.90%。凝固酶阴性葡萄球菌药敏结果示对青霉素、苯唑西林全耐药,对庆大霉素、左氧氟沙星耐药率80%,复方新诺明耐药62.5%。 结论我院泌尿外科2016年至2020年CMI逐年上升,在DDD波动稳定情况下,2020年我院多重耐菌数目明显减少,提示加强院感督导、严格落实多耐管理措施对多耐菌控制有重要作用。进一步对多重耐药菌进行分析,近5年多重耐药菌,革兰阴性菌主要为大肠埃希菌、肺炎克雷伯菌,革兰阳性菌主要是凝固酶阴性葡萄球菌。应定期对泌尿外科病原菌的分布及耐药性进行监测,指导临床合理应用抗菌药物。

Clinical distribution and antimicrobial resistance of multidrug-resistant organism infection of urinary system in our hospital in 2016 - 2020

ObjectiveTo investigate the distribution characteristics and antimicrobial resistance of multidrug-resistant organism, and provide evidence for clinical rational use of antimicrobial agents. MethodThe multidrug resistant bacterial spectrum and results of drug sensitivity test of 306 patients with multidrug-resistant infection in urology in the Sixth Affliliated Hospital of Sun Yat-sen University from January, 2016 to December, 2020 were retrospectively analyzed, including the number of multi-drug resistant bacteria, the types of multi-drug resistant bacteria, the distribution of submitted samples, and the drug sensitivity of multi-drug resistant bacteria. Case mix index (CMI) and defined daily dose(DDD) of the Department of Urology in our hospital from 2016 to 2020 were further discussed. ResultsA total of 306 cases of multi-drug resistant bacteria were detected. The number of drug-resistant bacteria in each year was 32, 53, 64, 111 and 46, respectively, and the detection rates were 11.1%, 7.5%, 10.1%, 9.1% and 4.2%, respectively. After comparison, the detection rate of multi-drug resistant bacteria in 2020 was significantly reduced, with statistical significance. In terms of the distribution of multi-drug resistant bacterial diseases, 99 cases (32.4%) were urinary calculi, 47 cases (15.4%) of urinary tract infection; 44 cases (14.4%) were urinary system tumors. In terms of the distribution of drug-resistant bacterial samples, 268 cases (87.6%) were midstream urine samples and 14 cases (4.6%) were blood samples.The top three multidrug-resistant bacteria were 223 cases (72.9%) of Escherichia coli, 43 cases (14.1%) of Klebsiella pneumoniae, and 19 cases (6.2%) of coagulase-negative staphylococci.Further drug resistance analysis showed that the antibacterial drugs with high drug resistance in large intestine were ceftazidime 69.10%, cefepime 65.00%, and ciprofloxacin 43.90%, respectively, and the antibacterial drugs with high drug resistance in Klebsiella pneumoniae were ceftazidime 60.50%, cefepime 55.80%, and ampicillin 41.90%.The drug sensitivity results of coagulase negative staphylococci showed that they were resistant to penicillin and oxacillin, 80% to gentamicin and levofloxacin, and 62.5% to cotrimoxazole. ConclusionsThe CMI of urology department in our hospital increased year by year from 2016 to 2020. Under the condition of stable fluctuation of DDD, the number of multiple resistant bacteria in our hospital decreased significantly in 2020, suggesting that strengthening the supervision of hospital sensation and strictly implementing the management measures of multiple resistant bacteria play an important role in the control of multiple resistant bacteria. Further analysis of multi-drug resistant bacteria showed that in recent 5 years, multi-drug resistant bacteria, negative bacteria were mainly Escherichia coli, Klebsiella pneumoniae, positive bacteria were mainly coagulase-negative staphylococci, the distribution and drug resistance of urological pathogens should be monitored regularly to guide the rational use of antibacterial drugs in clinical practice.