目的 探討2019—2021年天津市寶坻區(qū)人民醫(yī)院住院患者多重耐藥菌（MDRO）檢出及耐藥分析，為臨床抗菌藥物的合理應(yīng)用提供依據(jù)。方法 收集2019年1月—2021年12月天津市寶坻區(qū)人民醫(yī)院住院患者送檢標(biāo)本分離的MDRO，排除同一患者同一部位分離的重復(fù)菌株。采用法國(guó)生物梅里埃公司VITEK-2 Compact型全自動(dòng)微生物鑒定與藥敏分析儀進(jìn)行病原菌鑒定和藥敏試驗(yàn)。對(duì)臨床使用的3類(lèi)或3類(lèi)以上抗菌藥物同時(shí)呈現(xiàn)耐藥的細(xì)菌定義為MDRO并進(jìn)行耐藥分析。結(jié)果 檢出多重耐藥菌1 083株，其中產(chǎn)超廣譜β-內(nèi)酰胺酶（ESBLs）大腸埃希菌645株（59.56%）、產(chǎn)ESBLs肺炎克雷伯菌144株（13.3%）、多重耐藥鮑曼不動(dòng)桿菌（MDRAB）140株（12.93%）、耐甲氧西林金黃色葡萄球菌（MRSA）79株（7.29%）、多重耐藥銅綠假單胞菌（MDRPA）54株（4.99%）、耐碳青霉烯的腸桿菌（CRE）21株（1.94%）。2019—2021年，MDRAB、MDRPA和CRE的檢出率比較差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；組間比較，MDRAB的檢出率2021年高于2020年（P＜0.05），MDRPA和CRE的檢出率2021年高于2019年（P＜0.05）。標(biāo)本主要來(lái)源于痰液、尿液、分泌物，占比分別為37.12%，23.45%，18.01%。3年間檢出MDRO最高的科室為ICU，共167株（15.42%）。產(chǎn)ESBLs大腸埃希菌對(duì)氨芐西林、頭孢唑林、頭孢曲松、頭孢呋辛鈉、哌拉西林的耐藥率較高，均在90%以上，對(duì)美羅培南、亞胺培南、阿米卡星、頭孢替坦、哌拉西林/他唑巴坦敏感，敏感率在90%以上；產(chǎn)ESBLs肺炎克雷伯菌對(duì)氨芐西林、頭孢呋辛鈉、頭孢曲松、哌拉西林的耐藥率較高，均在90%以上，對(duì)美羅培南、亞胺培南、頭孢替坦和阿米卡星敏感，敏感率在90%以上；MDRAB僅對(duì)阿米卡星較敏感，敏感率在90%以上，對(duì)大部分抗菌藥耐藥率均較高；MDRPA對(duì)阿米卡星的敏感率為50%，對(duì)大部分抗菌藥耐藥率均較高。MRSA對(duì)利福平、復(fù)方新諾明、慶大霉素、環(huán)丙沙星、左氧氟沙星、莫西沙星的耐藥率在10%～20%，尚未發(fā)現(xiàn)對(duì)萬(wàn)古霉素、利奈唑胺、替加環(huán)素耐藥的菌株。結(jié)論 天津市寶坻區(qū)人民醫(yī)院分離的MDRO對(duì)抗菌藥物有不同程度的耐藥，加強(qiáng)病原學(xué)檢查及耐藥監(jiān)測(cè)有助于臨床合理選擇抗菌藥的種類(lèi)和劑量，減少多重耐藥菌的發(fā)生。

Objective To investigate the detection and analysis of multiple drug-resistant bacteria in hospitalized patients of Baodi District People's Hospital of Tianjin from 2019 to 2021, and to provide basis for rational clinical application of antibiotics. Results MDRO isolated from hospitalized patients in Baodi District People's Hospital of Tianjin from January 2019 to December 2021 was collected, and repeated strains isolated from the same patient at the same site were excluded. Vitek-2 Compact automatic microbiological identification and drug sensitivity analyzer from French Bio-Meriere company was used for pathogen identification and drug sensitivity test. Bacteria with concurrent resistance to three or more classes of antibiotics in clinical use were defined as MDRO and analyzed for resistance. 1 083 strains of multidrug-resistant bacteria were detected. Among them, ESBLs-Escherichia coli were 645 (59.56%), ESBLs-Klebsiella pneumoniae were 144 strains (13.3%), MDRAB were 140 strains (12.93%), MRSA were 79 strains (7.29%), MDRPA were 54 strains (4.99%), and CRE 21 strains (1.94%).From 2019 to 2021, the detection rates of MDRAB, MDRPA, and CRE were significantly different (P < 0.05). The detection rate of MDRAB in 2021 was higher than that in 2020 (P < 0.05), and the detection rate of MDRPA and CRE in 2021 was higher than that in 2019 (P < 0.05). The samples were mainly from sputum, urine, and secretions, accounting for 37.12%, 23.45% and 18.01%, respectively. The highest incidence of MDRO was found in ICU, with 167 strains (15.42%). ESBLs-Escherichia coli had high drug resistance rate to ampicillin, cefazolin, ceftriaxone, cefuroxime sodium, and piperacillin, all above 90%, and was sensitive to meropenem, imipenem, amikacin, cefotetan, piperacillin/tazobactam, the sensitivity rate was above 90%. ESBLs-Klebsiella pneumoniae had high drug resistance rate to ampicillin, cefuroxime sodium, ceftriaxone, and piperacillin, all above 90%, and was sensitive to meropenem, imipenem, ceftetan, and amicacin, the sensitivity rate was above 90%. MDRAB was only sensitive to amikacin, the sensitivity rate was more than 90%, and the resistance rate to most antibacterial drugs was high. The sensitivity rate of MDRPA to amikacin was 50%, and the resistance rate to most antibacterial drugs was high. The drug resistance rate of MRSA to rifampicin, cotrimoxazole, gentamicin, ciprofloxacin, levofloxacin and moxifloxacin ranged from 10% to 20%, but no resistant strains to vancomycin, linezolid and tigecycline were found. Conclusion MDRO isolated from Baodi District People's Hospital of Tianjin has different degrees of drug resistance to antibacterial drugs. Strengthening pathogenic examination and drug resistance monitoring is helpful to rationally select the type and dose of antibacterial drugs and reduce the occurrence of multiple drug resistance bacteria.

R978.1

天津市衛(wèi)生信息學(xué)會(huì)科研項(xiàng)目(TJHIA-2020-001)