不同重症监护病房多重耐药菌医院感染监测报告

Surveillance data of hospital-associated infections caused by multidrug-resistant organisms in intensive care units

    摘要
  • 摘要:
    目的 分析不同重症监护病房(ICU)多重耐药菌(MDROs)感染特点, 为精准感染防控提供数据支持。
    方法 通过医院感染实时监测系统对2016年1月-2023年12月苏州大学附属第一医院5个不同ICU患者的MDROs医院感染例次发病率、构成分布、感染部位及其耐药特征进行分析。
    结果 ICU患者中, MDROs医院感染1 322例次, 例次发病率为4.67%, 在不同ICU有所差异。主要为下呼吸道感染、血流感染和尿路感染, 占比分别为66.51%、14.53%和10.78%。不同ICU中感染部位分布、病原菌分布以及各感染部位病原谱均有所差别。总体上, 耐碳青霉烯类的肺炎克雷伯菌(CRKP)和鲍曼不动杆菌(CRAB)感染占比最高, 分别为35.63%(471/1322)和38.28%(506/1322)。CRKP菌株仅对多黏菌素B和头孢他啶/阿维巴坦耐药率较低, 对替加环素的耐药率为38.44%。CRAB菌株对多黏菌素B和替加环素的耐药率分别为10.00%和21.64%。耐碳青霉烯类铜绿假单胞菌(CRPA)对多数抗菌药物有较高的敏感性。耐甲氧西林金黄色葡萄球菌(MRSA)对四环素、左氧氟沙星、庆大霉素、莫西沙星和环丙沙星的耐药率较高。
    结论 临床应结合各ICU的MDROs监测结果指导合理用药以及采取针对性的感染防控措施。

     

    Abstract:
    OBJECTIVE To investigate the characteristics of multidrug-resistant organisms (MDROs) infections in the patients of intensive care units (ICUs) so as to provide supportive data for precise prevention and control of infections.
    METHODS From Jan. 2016 to Dec. 2023, the case-time incidence of hospital-associated MDROs infections, constituent ratios, infection sites and characteristics of drug resistance were observed and compared among the patients from 5 different ICUs of the First Affiliated Hospital of Suzhou University by means of real-time surveillance system of hospital-associated infection.
    RESULTS Among the ICU patients, there were 1322 case-times of hospital-associated infections with MDROs, and the case-time incidence rate was 4.67%, which varied in the ICUs. The patients with lower respiratory tract infections accounted for 66.51%, the patients with bloodstream infections 14.53%, the patients with urinary tract infections 10.78%. The distribution of infection sites, distribution of pathogens and etiological spectrum of infection sites varied according to the ICUs. In general, the percentages of carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Acinetobacter baumannii (CRAB) infections were highest, which were 35.63%(471/1322) and 38.28% (506/1322), respectively. The drug resistance rates of the CRKP strains to polymyxin B and ceftazidime-avibactam were low, and the drug resistance rate to tigecycline was 38.44%. The drug resistance rates of the CRAB strains to polymyxin B and tigecycline were 10.00% and 21.64%, respectively. The carbapenem-resistant Pseudomonas aeruginosa (CRPA) strains showed high sensitivity to most of the antibiotics. The drug resistance rates of the methicillin-resistant Staphylococcus aureus (MRSA) strains to tetracycline, levofloxacin, gentamicin, moxifloxacin and ciprofloxacin were high.
    CONCLUSION It is necessary for the hospital to reasonably use antibiotics based on the result of surveillance of MDROs in the ICUs and take targeted prevention measures for the infections.

     

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