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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
杜凤英
刘一凡
作者及单位信息
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DOI： 10.3760/cma.j.cn341190-20240808-01017
Clinical distribution and antibiotic resistance analysis of multidrug-resistant organism infections in a non-intensive care unit of a hospital from 2020 to 2023
Du Fengying
Liu Yifan
Authors Info & Affiliations
Du Fengying
Department of Infection Management, Suqian First Hospital, Jiangsu Provincial (Suqian) Hospital, Suqian 223800, Jiangsu Province, China
Liu Yifan
Department of Rehabilitation Medicine, Suqian First Hospital, Jiangsu Provincial (Suqian) Hospital, Suqian 223800, Jiangsu Province, China
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DOI： 10.3760/cma.j.cn341190-20240808-01017
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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%（782/5 750）；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%（96/3 693）。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。

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
ABSTRACT

ObjectiveTo 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.

MethodsUsing 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.

ResultsThe average detection rate of MDRO in non-ICU over 4 consecutive years was 13.60% (782/5 750). 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% (96/3 693), 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 compared to hospital-acquired infections (63.25% vs. 38.03%, χ 2 = 16.23, P < 0.05). The lower respiratory tract was identified as the primary site for community-acquired infections. Antimicrobial susceptibility testing revealed that CRAB was 100% resistant to penicillins, carbapenems, and most cephalosporins. CRPA demonstrated 100% resistance to penicillins and trimethoprim-sulfamethoxazole, but showed lower resistance rates for other antibiotics compared to CRAB and carbapenem-resistant Klebsiella pneumoniae. MRSA was 100% resistant to penicillin and cefoxitin, but exhibited a resistance rate of 0% to tigecycline and linezolid.

ConclusionsIn our hospital, 86.35% of MDRO infections in non-ICU departments originated from the community, primarily involving MRSA and CRPA. There were significant differences in the proportion of MDRO infections across different departments, and resistance to carbapenem antibiotics was serious. Infection prevention and control departments should implement targeted prevention strategies based on these distribution characteristics.

Bacteria;Drug resistance, multiple;Cross infection;Infection control;Microbial sensitivity tests;Methicillin-resistant staphylococcus aureus;Pseudomonas aeruginosa
Du Fengying, Email: mocdef.qabq8287981792
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引用本文

杜凤英,刘一凡. 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[J]. 中国基层医药,2025,32(03)：364-370.

DOI:10.3760/cma.j.cn341190-20240808-01017

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近年来，随着医疗技术的不断进步，各种有创诊疗操作的普及以及广谱抗菌药物使用，导致多重耐药菌（multi-drug resistant bacteria，MDRO）感染日益剧增，增加患者痛苦，延长住院时间，给患者、社会、医院带来巨大经济负担 ［ 1 , 2 , 3 ］ 。据世界卫生组织报道，欧美等国家每年死于MDRO感染患者20 000余人，造成严重的经济损失 ［ 4 ］ 。因此，MDRO感染目前成为全球性的公共卫生问题。由于重症监护病房（ICU）患者易感因素多，相对于非ICU患者更容易引起MDRO感染。因此，国内外研究ICU患者MDRO感染的较多，单独进行非ICU科室MDRO感染问题研究相对较少。对于非ICU科室MDRO检出率、科室分布和耐药率等相关问题感染防控部门应认真分析及思考。此研究收集我院非ICU科室住院患者分离出MDRO感染菌株对其分析，为落实有效的MDRO感染防控提供依据。
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备注信息
A
杜凤英，Email： mocdef.qabq8287981792
B

杜凤英：采集数据、起草文章、论文修改；刘一凡：数据整理、统计分析、技术支持

C
杜凤英,刘一凡.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[J].中国基层医药,2025,32(3):364-370.DOI:10.3760/cma.j.cn341190-20240808-01017.
D
所有作者声明不存在利益冲突
E
江苏省卫生健康委预防医学科研课题面上项目 (Ym2023100)
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