目的 分析南京醫(yī)科大學(xué)附屬逸夫醫(yī)院耐碳青霉烯類革蘭陰性菌的臨床分布特征以及耐藥情況，為醫(yī)院感染的控制和臨床治療策略的優(yōu)化提供參考。方法 對2017—2019年南京醫(yī)科大學(xué)附屬逸夫醫(yī)院耐碳青霉烯類革蘭陰性菌菌株標(biāo)本類型、科室分布、年齡分布、菌株種類和耐藥性特點(diǎn)進(jìn)行統(tǒng)計(jì)和分析。結(jié)果 2017—2019年南京醫(yī)科大學(xué)附屬逸夫醫(yī)院共分離得到耐碳青霉烯類革蘭陰性菌591株，平均分離率為11.7%，其中耐碳青霉烯類鮑曼不動桿菌（CRAB）198株（33.5%），與耐碳青霉烯類銅綠假單胞菌（CRPA）和耐碳青霉烯類腸桿菌科細(xì)菌（CRE）的分離率相比較高，差異顯著（P<0.05）；分離耐碳青霉烯類革蘭陰性菌的標(biāo)本主要為痰和肺泡灌洗液（402株，68.0%），差異顯著（P<0.05）；耐碳青霉烯類革蘭陰性菌的分布人群集中在61～90歲，其中81～90歲的耐碳青霉烯類革蘭陰性菌的分離率與其他年齡段相比較高，差異顯著（P<0.05）；耐碳青霉烯類革蘭陰性菌主要分布于ICU（37.7%），呼吸科病房（23.7%），神經(jīng)外科病房（12.4%）及老年醫(yī)學(xué)科病房（7.6%），其檢出率與其他科室相比均較高，差異顯著（P<0.05）；CRE菌株對阿米卡星的耐藥率與其他抗菌藥物相比較低，差異顯著（P<0.05），CRAB對臨床常用抗菌藥物均呈高度耐藥（平均耐藥率>94.3%），CRPA菌株對阿米卡星的耐藥率與其他抗菌藥物相比較低，差異顯著（P<0.05）。結(jié)論 南京醫(yī)科大學(xué)附屬逸夫醫(yī)院耐碳青霉烯類革蘭陰性菌分離率較高，且高度耐藥。本研究為醫(yī)院感染控制策略的優(yōu)化提供基線實(shí)驗(yàn)數(shù)據(jù)，同時強(qiáng)調(diào)在防控多重耐藥菌播散中持續(xù)監(jiān)測耐藥性以及規(guī)范使用抗菌藥物的必要性。

Objective To investigate the clinical distribution characteristics and drug resistance of CRGN (carbapenems resistant Gram-negative bacteria) in Sir Run Run Hospital of Nanjing Medical University, and to offer evidence to hospital infection control and clinical therapy strategy. Methods The data of isolated CRGN strains during 2017-2019 were collected and analyzed by their sample type, clinical department distribution, age distribution, strain distribution and drug resistance rate. Results Total amount of isolation of CRGN from 2017 to 2019 is 591(average isolation rate 11.7%) strains. The isolation of CRAB (Carbapenem-resistant Acinetobacter baumannii) strains (198 strains, 33.5%) was statistically significantly higher than both the isolation of CRPA (Carbapenem-resistant Pseudomonas aeruginosa) and CRE (Carbapenem-resistant Enterobacteriaeae) (P<0.05). The most samples that isolated CRGN was sputum and Bronchoalveolar Lavage Fluid (BALF) sample (402 strains, 68.0%), which was statistically significantly higher than the other samples (P<0.05). The age of patients that isolated was mainly ranged from 61 to 90, amongst them the isolation of CRGN between 81 and 90 was statistically significantly higher than the other age ranges (P<0.05). The CRGN mainly distributed in Intensive care unit (ICU) (37.7%), Respiratory (23.7%), Neurosurgery (12.4%) and Geriatrics (7.6%) department. The isolation rates of these departments were statistically significantly higher (P<0.05). The drug resistance rate of CRE strains towards amikacin was statistically significantly lower than the other antibiotics (P<0.05). CRAB was highly resistant towards antibiotics commonly used in clinic (the average drug resistance rate > 94.3%). Conclusion The rate of isolation of CRGN strains was high, and the drug resistance towards antibiotics was severe in the Tertiary hospital. This study offers baseline data to optimize the strategy of hospital infection control, and emphasize the importance of monitoring the bacteria resistance and the necessity of rationalization of antibiotics use.

R978.1

南京醫(yī)科大學(xué)科技發(fā)展基金面上資助項(xiàng)目（2017NJMU214）