广东某医院多重耐药细菌监测现状

目的 了解广东某三甲医院多重耐药细菌感染现状,为预防多重耐药细菌感染和治疗提供依据。方法 收集2019年1月—2020年6月住院患者分离的多重耐药菌株耐药性检测资料,并进行回顾性分析。结果 2019年1月—2020年6月共检出病原菌6 992株,其中多重耐药细菌2 458株,多重耐药率为35.15%。CRPA、CRABA、ESBLs、CRE、MRSA、VRE的检出率分别为44.5%（550/1 236）、70.5%（418/593）、33.9%（914/2 696）、3.4%（93/2 696）、61.7%（476/772）、1.2%（7/568）。ESBLs和VRE以中段尿标本检出为主,CRPA、CRABA、CRE和MRSA以痰标本检出为主。多重耐药细菌检出科室主要集中在ICU、神经外科、老年科、康复科、呼吸内科、泌尿外科。≥60岁患者1 662例（占67.6%）。MRSA和MSSA、 VRE和VSE、 CRE和CSE、ESBLs⁺和ESBLs^-、 CRPA和CSPA、CRABA和CSABA 对抗生素耐药率超过50%分别为58.8%（10/17）和5.9%（1/17）、84.6%（11/13）和30.8%（4/13）、 95.5%（21/22）和9.1%（2/22）、40.9%（9/22）和4.5%（1/22）、25.0%（3/12）和0%（0/12）、93.3%（14/15）和0%（0/15） （均 P<0.01）。结论 多重耐药细菌检出情况较严峻,为减少多重耐药细菌的产生,应加强临床抗菌药物的合理使用,对于ICU和老年患者居多的科室,应注意手卫生,减少医疗侵袭性操作,减少多重耐药细菌的产生,从而减少患者和医院的负担。

Monitoring status of multidrug resistant bacteria in a hospital of Guangdong

Objective To understand the current situation of multidrug resistant bacterial infection in a hospital of Guangdong, we provide a basis for prevention and treatment of multi-drug resistant bacterial infection. Methods The multidrug resistant strains isolated from inpatients in our hospital from January 2019 to June 2020 were retrospectively analyzed. Results From January 2019 to June 2020, 6 992 strains of pathogenic bacteria and 2 458 strains of multidrug resistant bacteria were detected in our hospital, the multiple drug resistance rate was 35.15%. The detection rates of CRPA, CRABA, ESBLs, CRE, MRSA and VRE were 44.5% (550/1 236), 70.5% (418/593), 33.9% (914/2 696), 3.4% (93/2 696), 61.7% (476/772), and 1.2%(7/568), respectively. ESBLs and VRE were mainly detected in urine samples, CRPA, CRABA, CRE and MRSA were mainly detected in sputum samples. The detection departments of MDR bacteria in our hospital mainly concentrated in ICU, neurosurgery, geriatrics, rehabilitation, respiratory medicine, urology. The age distribution of patients with multidrug resistant bacterial infection was mainly over 60 years old (1 662 cases, 67.6%). he antibiotic resistance rate of MRSA and MSSA, VRE and VSE, CRE and CSE, ESBLs+ and ESBLs-, CRPA and CSPA, CRABA and CSABA was 58.8% (10/17) and 5.9% (1/17), 84.6% (11/13) and 30.8% (4/13), 95.5% (21/22) and 9.1% (2/22), 40.9% (9/22) and 4.5% (1/22), 25.0% (3/12) and 0% (0/12), 93.3% (14/15) and 0% (0/15) (all P<0.01). Conclusion In order to reduce the production of multidrug-resistant bacteria in our hospital, we should strengthen the rational use of clinical antibiotics. To reduce the production of multidrug-resistant bacteria and reduce the burden of patients and hospitals, we should pay attention to hand hygiene and reduce medical invasive operation for ICU and departments with the majority of elderly patients.