多重耐药菌株增加：2015年至2017年上海66家医院面临的新临床负担
Increased multidrug resistant isolates: new clinical burdens for 66 hospitals in Shanghai, 2015 to 2017.
作者信息
Lin Jiabing, Gao Xiaodong, Cui Yangwen, Sun Wei, Shen Yan, Shi Qingfeng, Chen Xiang, Hu Bijie
机构信息
Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
出版信息
Ann Transl Med. 2020 Feb;8(4):112. doi: 10.21037/atm.2019.12.91.
BACKGROUND
To investigate the etiology of urinary tract and respiratory infections and the rate of drug resistant bacteria in Shanghai from 2015 to 2017, provide the support to the promotion of the correct clinical etiological specimens detection.
METHODS
The retrospective questionnaire survey was conducted to obtain the antibiotic prescription rate, pathogen detection rate, and isolation rate of drug-resistant bacteria of the inpatients in 66 hospitals of Shanghai in 2015 and 2017.
RESULTS
Although the detection rate of multidrug-resistant bacteria in sputum specimens has decreased, the clinical pathogen detection still relied mainly on sputum specimens in 2017. Among the sputum specis, the detection rates of (ESBL-ESC), (ESBL-KP), (CRAB), (CRPA) and (MRSA) in 2017 were 66.67%, 32.46%, 61.74%, 32.01% and 58.55% respectively. The detection rates of ESBL-ESC, ESBL-KP, CRAB, CRPA in 2017 were increased while the MRSA was decreased than 2015 (P<0.001). Among the blood samples, the detection rates of ESBL-ESC, ESBL-KP, CRAB, CRPA, MRSA and vancomycin-resistant Enterococcus sp (VRE) in 2017 were 53.71%, 31.43%, 50.80%, 19.43%, 43.87% and 0.55% respectively. The detection rates of ESBL-KP, CRAB, CRPA and MRSA increased while the rates of ESBL-ESC and VRE decreased compared with 2015 (P<0.005). The pathogens of multi-drug resistant bacteria were mainly detected from sputum specimens in 2017, which were all higher than detected from the blood specimens (P<0.001).
CONCLUSIONS
Most of the multi-drug resistant bacteria in Shanghai, especially in Acinetobacter baumannii or Pseudomonas aeruginosa are mainly detected from sputum specimens, indicating that the actual drug resistance may be overestimated.
背景
调查2015年至2017年上海地区泌尿系统和呼吸道感染的病因及耐药菌发生率，为推动临床病原学标本正确检测提供依据。
方法
采用回顾性问卷调查，获取2015年和2017年上海66家医院住院患者的抗生素处方率、病原体检出率及耐药菌分离率。
结果
2017年痰标本中多重耐药菌检出率虽有所下降，但临床病原体检测仍主要依赖痰标本。在痰标本中，2017年超广谱β-内酰胺酶肠杆菌科细菌（ESBL-ESC）、超广谱β-内酰胺酶肺炎克雷伯菌（ESBL-KP）、耐碳青霉烯类鲍曼不动杆菌（CRAB）、耐碳青霉烯类铜绿假单胞菌（CRPA）和耐甲氧西林金黄色葡萄球菌（MRSA）的检出率分别为66.67%、32.46%、61.74%、32.01%和58.55%。与2015年相比，2017年ESBL-ESC、ESBL-KP、CRAB、CRPA的检出率升高，MRSA的检出率下降（P<0.001）。在血标本中，2017年ESBL-ESC、ESBL-KP、CRAB、CRPA、MRSA和耐万古霉素肠球菌（VRE）的检出率分别为53.71%、31.43%、50.80%、19.43%、43.87%和0.55%。与2015年相比，ESBL-KP、CRAB、CRPA和MRSA的检出率升高，ESBL-ESC和VRE的检出率下降（P<0.005）。2017年多重耐药菌病原体主要从痰标本中检出，均高于血标本中的检出率（P<0.001）。
结论
上海地区多数多重耐药菌，尤其是鲍曼不动杆菌或铜绿假单胞菌主要从痰标本中检出，提示实际耐药情况可能被高估。
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