耐碳青霉烯类病原菌分布特征及耐药性分析

目的 调查某三级甲等医院近3年耐碳青霉烯类病原菌的分布特征及耐药性。方法 对2016—2018年住院患者送检的临床标本中的耐碳青霉烯类鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii, CRAB)、耐碳青霉烯类铜绿假单胞菌(carbapenem-resistant Pseudomonas aeruginosa, CRPA)、耐碳青霉烯类大肠埃希菌(carbapenem-resistant Escherichia coli, CREC)和耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumonia, CRKP)的检出、分布及耐药情况进行分析。结果 2016—2018年间共分离出这4种常见耐碳青霉烯类病原菌(carbapenem-resistant organism, CRO)总数分别为233、338和523株，近3年CRAB、CRPA和CREC检出率分别为66.16%、13.69%和1.98%，3年变化不明显；CRKP 3年检出率分别为2.38%、4.25%和20.62%，成明显上升趋势。CRAB和CRPA标本均主要来源于下呼吸道，科室主要来源于神经外科和重症监护室(intensive care unit, ICU)；CREC标本主要来源于下呼吸道、尿液和血液，科室来源主要是泌尿外科、新生儿科和ICU；CRKP标本主要来源于下呼吸道，科室来源主要是神经外科、ICU和新生儿科。CRO对其他药物耐药情况严峻，CRAB除替加环素和米诺环素外其他药物的耐药率均在70%以上；CRPA对于庆大霉素、阿米卡星、妥布霉素及哌拉西林/三唑巴坦耐药率在30%以下，其他耐药率较高；CREC除了阿米卡星和呋喃妥因耐药率30%以下，其他药物耐药率均在60%以上，CRKP对常用药物耐药率均在70%以上，CREC和CRKP对替加环素耐药率为0。结论

Distribution and drug resistance of carbapenem-resistant organism

Objective To investigate the changes in distribution and drug resistance of carbapenem-resistant organism (CRO) in a third-grade hospital in the past three years. Methods To analyze the detection, distribution, and drug resistance of carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), carbapenem-resistant Escherichia coli (CREC), and carbapenem-resistant Klebsiella pneumoniae (CRKP) in clinical specimens submitted for inpatients from 2016 to 2018. Results The total number of these four common CRO was 233, 338, and 523 respectively in 2016—2018. The detection rates of CRAB, CRPA, and CREC were 66.16%, 13.69%, and 1.98%, and these changes were not obvious; the detection rates of CRKP were 2.38%, 4.25%, and 20.62% respectively from 2016 to 2018, which showed a clear upward trend. The CRAB and CRPA specimens were mainly from the lower respiratory tract, and the main sources of the departments were neurosurgery and intensive care unit (ICU); the CREC specimens were mainly from lower respiratory tract, urine, and blood, and the main sources of the departments were urology and neonatology and ICU; the CRKP specimens were mainly from the lower respiratory tract, and the main source of the departments were neurosurgery, ICU, and neonatology. CRO was also resistant to other drugs, CRAB had a resistance rate of more than 70% except for tigecyeline and minocycline; the resistance rates of CRPA to gentamicin, amikacin, tobramycin, and piperacillin/tazobactam were below 30% and the resistance rates to other drugs were higher; the resistance rates of CREC were less than 30% except for amikacin and nitrofurantoin and the resistance rates to other drugs were above 60%; the resistance rates of CRKP to common drugs were above 70%. The resistance rates of CRKP and CREC to tigecyeline were 0. Conclusion Among the four common CRO in our hospital, the drug resistance detection rates of CRAB, CRPA and CREC slightly decreased, while CRKP showed a significant upward trend. Departments of neurosurgery and ICU had a high risk of multidrug-resistant organism (MDRO) in our hospital and the main infection type was pulmonary infection. The rate of hospital infection was high and CRO was highly resistant to commonly used antibiotics, and thus medical institutions should take active and effective measures to prevent further spread of MDRO.