Abstract:

Objective　To analyze the distribution and drug resistance characteristics of Carbapenem resistant Gram-negative bacilli (CR-GNB) isolated from Guangdong Provincial Second Hospital of Traditional Chinese Medicine. Methods　From January 1, 2021 to June 30, 2023, 2 754 strains of CR-GNB were identified by clinical isolation and identification in Guangdong Provincial Second Hospital of Traditional Chinese Medicine. The WHONET5.6 software was used to analyze the distribution characteristics of CR-GNB and the characteristics of drug susceptibility detection resistance. Results　A total of 2 754 strains of CR-GNB were clinically isolated and screened, including 843 strains of carbapenem-resistant Klebsiella pneumoniae (CRKP), accounting for 30.6%, 765 strains of Carbapenem-resistant Acinetobacter baumannii (CRAB), accounting for 27.8%, 679 strains of Carbapenem-resistant Pseudomonas aeruginosa (CRPA), accounting for 24.7%, 203 strains of carbapenem-resistant Escherichia coli (CREC), accounting for 7.4%, and 264 strains of other CR-GNB, accounting for 9.5%. The main sources of CR-GNB samples were sputum (1 702 strains, 61.8%), urine (639 strains, 23.2%), alveolar lavage fluid (232 strains, 8.4%), blood (78 strains, 2.8%), and secretions (71 strains, 2.6%). The main departments were respiratory and critical care medicine (532 strains, 19.3%), intensive care medicine (365 strains, 13.3%), Acupuncture Kang District 1 (325 strains, 11.8%), and Acupuncture Kang District 7 (181 strains, 6.6%). A total of 1 330 strains (48.9%) were isolated from the Acupuncture Kang Districts. CR-GNB generally has multiple drug resistance or pan-resistance to antibiotics, and the sensitivity rate of a few drugs is high. The sensitivity rate of CRKP to tigacycline was 100.0%. The sensitivity rates of CRAB to amikacin, tobramycin, and minocycline were 73.9%, 59.0%, and 49.3%, respectively. The sensitivity rates of CRPA to amikacin, tobramycin, and polymyxin B were 78.1%, 75.5%, and 46.5%, respectively. The sensitivity rate of CREC to tigecycline was 100.0%. Conclusions　The CR-GNB isolated in Guangdong Provincial Second Hospital of Traditional Chinese Medicine are mainly CRKP, CRAB, CRPA, and CREC. CR-GNB is multi-drug resistant or pan-resistant, and the available therapeutic drugs are limited. Clinical use of antibiotics should be regulated, and effective and feasible treatment plans should be formulated according to the drug resistant characteristics of CR-GNB to prevent nosocomial infection and spread of CR-GNB.

Key words:

Carbapenem resistant Gram-negative bacilli, Distribution characteristics, Drug resistance

摘要：

目的　分析广东省第二中医院临床分离碳青霉烯类耐药革兰阴性杆菌（Carbapenem resistant Gram-negative bacilli，CR-GNB）的分布情况和耐药性特点。方法　选取广东省第二中医院2021年1月1日至2023年6月30日经临床分离鉴定检测的2 754株CR-GNB；使用WHONET5.6软件分析CR-GNB的分布特征及药敏检测耐药性特点。结果　临床分离筛选出CR-GNB 2 754株，其中，碳青霉烯类耐药肺炎克雷伯氏菌（Carbapenem resistant Klebsiella pneumoniae，CRKP）843株（30.6%），碳青霉烯类耐药鲍曼不动杆菌（Carbapenem-resistant Acinetobacter baumannii，CRAB）765株（27.8%），碳青霉烯类耐药铜绿假单胞菌（Carbapenem-resistant Pseudomonas aeruginosa，CRPA）679株（24.7%），碳青霉烯类耐药大肠埃希菌（Carbapenem-resistant Escherichia coli，CREC）203株（7.4%），其他CR-GNB 264株（9.5%）。CR-GNB主要标本来源：痰液1 702株（61.8%），尿液639株（23.2%），肺泡灌洗液232株（8.4%），血液78株（2.8%），分泌物71株（2.6%）。主要科室分布：呼吸与危重症医学科病区532株（19.3%），重症医学科病区365株（13.3%），针康一区病区325株（11.8%），针康七区病区181株（6.6%）。针康病区合计分离出1 330株（48.9%）。CR-GNB普遍对抗生素存在多重耐药或泛耐药，对少数药物敏感率较高；CRKP对替加环素的敏感率是100.0%；CRAB对阿米卡星、妥布霉素、米诺环素的敏感率分别是73.9%、59.0%、49.3%；CRPA对阿米卡星、妥布霉素、多黏菌素B的敏感率分别为78.1%、75.5%、46.5%；CREC对替加环素的敏感率为100.0%。结论　广东省第二中医院临床分离的CR-GNB以CRKP、CRAB、CRPA和CREC为主。CR-GNB呈多重耐药或泛耐药，可选择的治疗药物有限，临床需规范抗生素的使用，同时根据CR-GNB的耐药特点制定有效可行的治疗方案，防范CR-GNB在院内感染和传播。

关键词:

碳青霉烯类耐药革兰阴性杆菌, 分布特点, 耐药性