2024年浦东新区医疗机构多重耐药菌监测报告

Surveillance report of multidrug-resistant bacteria in medical institutions of Pudong New Area in 2024

  • 摘要:
    目的 了解浦东新区医疗机构中多重耐药菌的感染/定植流行情况及为制定有效的防控措施提供科学依据。
    方法 对浦东新区10家医疗机构开展多重耐药菌感染情况的综合监测, 监测体系涵盖病例样本、环境样本及医护人员定植携带情况。
    结果 多重耐药菌在区医疗机构中广泛流行, 耐碳青霉烯类鲍曼不动杆菌(CRAB)和耐碳青霉烯类肺炎克雷伯菌(CRKP)为主要菌株, 检出率分别为35.49%和28.41%。ICU病例占比超40%, 且检出率呈显著上升趋势(P=0.007)。环境中鲍曼不动杆菌检出率5.24%(66/1 260), 主要污染手、水龙头等接触表面。医护人员存在耐药菌定植, 3名手-鼻腔共定植者中2名同时携带金黄色葡萄球菌与鲍曼不动杆菌, 提示传播途径复杂。病例样本的耐药率最高, 环境样本次之, 医护人员定植样本的耐药率相对最低。临床分离株对关键药物呈现极端耐药, CRAB对碳青霉烯类耐药率超过96.8%, CRKP对氨苄西林耐药率100.00%。
    结论 多重耐药菌在浦东新区医疗机构中的流行情况严峻, 尤其在重症监护室需重点关注。医护人员定植现象提示耐药菌传播的潜在风险, 需进一步加强手卫生、环境清洁消毒及抗菌药物合理使用等综合防控措施。

     

    Abstract:
    OBJECTIVE To investigate the prevalence of multidrug-resistant bacteria infection/colonization in medical institutions of Pudong New Area and provide scientific evidence for formulating effective prevention and control measures.
    METHODS Comprehensive monitoring of multidrug-resistant bacterial infections was conducted in 10 medical institutions of Pudong New Area, covering case samples, environmental samples and colonization carriage among healthcare workers.
    RESULTS Multidrug-resistant bacteria were widely prevalent in medical institutions in Pudong New Area. Carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP) were the dominant strains, with detection rates of 35.49% and 28.41%, respectively. ICU cases accounted for over 40%, and the detection rate showed a significant increasing trend (P=0.007). The detection rate of A. baumannii in the environment was 5.24% (66/1 260), mainly contaminating contact surfaces such as hands and faucets. Colonization with drug-resistant bacteria was observed among healthcare workers, with 2 out of 3 co-colonized individuals carrying both Staphylococcus aureus and A. baumannii, indicating complex transmission routes. The resistance rate was highest in case samples, followed by environmental samples, and relatively lowest in colonization samples from healthcare workers. Clinical isolates exhibited extreme resistance to key drugs, with CRAB showing over 96.8% resistance to carbapenems and CRKP showing 100.00% resistance to ampicillin.
    CONCLUSIONS The prevalence of multidrug-resistant bacteria in medical institutions of Pudong New Area is severe, particularly in intensive care units, which require special attention. Colonization among healthcare workers suggests potential risks for drug-resistant bacterial transmission, necessitating further strengthening of hand hygiene, environmental cleaning and disinfection, rational use of antibacterial agents and other comprehensive prevention and control measures.

     

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