中国一家三级医院耐药性的纵向研究：表型流行病学分析（2013 - 2018年） - Suppr

Longitudinal Study of the Drug Resistance in of a Tertiary Hospital, China: Phenotypic Epidemiology Analysis (2013-2018).

作者信息

Pei Na, Liu Qingxia, Cheng Xinyi, Liang Tianzhu, Jian Zijuan, Wang Siyi, Zhong Yiming, He Jingxuan, Zhou Mao, Kristiansen Karsten, Chen Weijun, Liu Wenen, Li Junhua

机构信息

BGI-Shenzhen, Shenzhen, 518083, People's Republic of China.

Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark.

出版信息

Infect Drug Resist. 2021 Feb 17;14:613-626. doi: 10.2147/IDR.S294989. eCollection 2021.

PURPOSE

Multi-drug resistant (MDR KP) is spreading worldwide and has posed a huge medical burden to public health. However, studies on drug resistance surveillance of KP, especially MDR KP, with a large longitudinal sample size in a tertiary hospital are rare. This study aims to investigate phenotypic epidemiology characteristics of 4128 KP isolates in a Chinese tertiary hospital covering a period of 5 years.

METHODS

All the KP clinical isolates were retrospectively collected from a tertiary hospital in Hunan province of China from Jan 5, 2013 to Jul 24, 2018. All the isolates were identified by MALDI-TOF MS analysis. Twenty-four antimicrobial agents were tested by antimicrobial susceptibility testing. Fisher exact test and logistic regression were used to analyze the association between clinical factors and antimicrobial non-susceptibility for seven second-choice antimicrobials.

RESULTS

A total of 4128 KP isolates were collected in our study. The non-susceptible rates (NSRs) to ertapenem, imipenem and tigecycline increased considerably from 2013 to 2018 (13.6% to 28.6%, 10.1% to 28.9%, 10.8% to 46.5%, respectively). Amikacin presents the lowest NSR among 3 aminoglycosides (3.8-22.8%). The multi-drug NSRs among KP isolates to second-choice antimicrobials (88.6-100%) were higher than to all drugs (68.0%). The NSRs varied significantly among departments and sample sources. Higher ETP/IPM/AK NSRs (39.8/39.7/30.6%) were observed in Intensive Care Unit, and ETP/IPM non-susceptible isolates tended to distribute in cerebrospinal fluid. From 2015 to 2017, the NSRs of ETP, IPM, and AK showed an opposite trend of seasonal fluctuations to SXT.

CONCLUSION

Higher multi-drug resistance (MDR) rates were observed in KP isolates to second-choice antimicrobials than to others, among which MDR rates to carbapenems or AK are the highest. A unique pattern of MIC and time distributions of MDR were observed. Clinical factors including gender were correlated with MDR rates of KP. Isolates in ICU and CSF showed higher NSRs in carbapenems which should be paid more attention to, and temporal distribution of NSRs was observed.

目的

多重耐药肺炎克雷伯菌（MDR KP）正在全球范围内传播，给公共卫生带来了巨大的医疗负担。然而，在一家三级医院中，对肺炎克雷伯菌，尤其是多重耐药肺炎克雷伯菌进行大样本纵向耐药监测的研究却很少见。本研究旨在调查一家中国三级医院5年间收集的4128株肺炎克雷伯菌分离株的表型流行病学特征。

方法

回顾性收集2013年1月5日至2018年7月24日期间中国湖南省一家三级医院的所有肺炎克雷伯菌临床分离株。所有分离株均通过基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）分析进行鉴定。采用药敏试验检测24种抗菌药物。使用Fisher精确检验和逻辑回归分析临床因素与7种二线抗菌药物耐药性之间的关联。

结果

本研究共收集了4128株肺炎克雷伯菌分离株。从2013年到2018年，厄他培南、亚胺培南和替加环素的不敏感率（NSR）显著上升（分别从13.6%升至28.6%、10.1%升至28.9%、10.8%升至46.5%）。阿米卡星在3种氨基糖苷类药物中不敏感率最低（3.8%-22.8%）。肺炎克雷伯菌分离株对二线抗菌药物的多重耐药不敏感率（88.6%-100%）高于对所有药物的不敏感率（68.0%）。各科室和样本来源的不敏感率差异显著。重症监护病房观察到较高的厄他培南/亚胺培南/阿米卡星不敏感率（39.8/39.7/30.6%），且厄他培南/亚胺培南不敏感分离株倾向于分布在脑脊液中。2015年至2017年，厄他培南、亚胺培南和阿米卡星的不敏感率与磺胺甲恶唑呈现相反的季节性波动趋势。

结论

肺炎克雷伯菌分离株对二线抗菌药物的多重耐药率高于对其他药物的多重耐药率，其中对碳青霉烯类或阿米卡星的多重耐药率最高。观察到多重耐药的最低抑菌浓度（MIC）和时间分布的独特模式。包括性别在内的临床因素与肺炎克雷伯菌的多重耐药率相关。重症监护病房和脑脊液中的分离株对碳青霉烯类药物表现出较高的不敏感率，应予以更多关注，且观察到不敏感率的时间分布情况。