Clinical isolates of multi drug resistant bacteria in a hospital from 2017 to 2021 in Jiading District of Shanghai

doi:10.16150/j.1671-2870.2022.01.012

Abstract

Abstract:

Objective: To analyze detection rate and changing trend of clinical multi-drug resistant bacteria(MDRB) in recent 5 years, and explore drug resistance characteristics of carbapenem resistant gram-negative bacteria, so as to provide reference for nosocomial infection prevention and control and empirical treatment of antibiotics in clinical practice. Methods: Seven kinds of MDRB isolated from clinical specimens of hospitalized patients during January 2017 to December 2021 were retrospectively analyzed, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus (VRE), extended spectrum β-lactamases producing Escherichia coli (ESBL-eco), extended spectrum β-lactamases producing Klebsiella pneumoniae (ESBL-kpn), carbapenem resistant Enterobacteriaceae (CRE), carbapenem resistant Acinetobacter baumannii (CR-AB) and carbapenem resistant Pseudomonas aeruginosa (CR-PA). The rate of carbapenem resistant gram-negative bacilli to common antibiotics and the carbapenemase production of CRE strain were analyzed with SPSS 20.0. Results: VRE was not detected in this study. Except ESBL-eco, the isolated rates of the other five MDRB increased in the past five years. The detection rates of MRSA, ESBL-kpn, CRE, CR-AB and CR-PA fluctuated between 37.0%-53.6%, 19.3%-34.3%, 2.5%-10.6%, 34.1%-63.4% and 11.3%-22.8%, respectively. It revealed that 65.4% CRE, 72.0% CR-AB, and 59.3% CR-PA isolates were isolated from ICU. The resistant rates of CRE and CR-AB to quinolones, cephalosporins and β-Lactamase inhibitor complex were 90.0%. Among 272 CRE strains, 221 strains were Klebsiella pneumoniae, accounting for 81.3%. The carbapenemase was detected in 90 strains of CRE, in which three kinds of carbapenemases (KPC, NDM and IMP) were detected and the constituent ratio of KPC enzyme was 90.0%. Conclusions: The isolated rates of six MDRB in this study are much lower than the average level in Shanghai and national tertiary hospitals in the same period, but the isolated rates of MRSA, ESBL-kpn, CRE, CR-AB and CR-PA show an upward trend, which should be paid attention to, especially the carbapenem resistant gram-negative bacteria in ICU. In this study, 90 strains of CRE tested produced three kinds of carbapenem enzymes, in which KPC enzymes showed a high proportion.

Key words: Multi-drug resistant bacteria, Detection rate, Intensive care unit, Carbapenem resistant Enterobacteriaceae, Carbapenemase

CLC Number:

R446.5

LI Li, ZHU Yongzhen, ZHOU Min, QIAN Jia, FANG Lili. Clinical isolates of multi drug resistant bacteria in a hospital from 2017 to 2021 in Jiading District of Shanghai[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(01): 62-67.

Figures/Tables 5

References 14

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菌株	2017年		2018年		2019年		2020年		2021年
菌株	住院部	ICU	住院部	ICU	住院部	ICU	住院部	ICU	住院部	ICU
金黄色葡萄球菌（株）	70	9	71	20	108	32	83	30	112	37
MRSA[n（%）]	30（42.9）	5（55.6）	32（45.1）	10（50.0）	40（37.0）	16（50.0）	31（37.4）	13（43.3）	60（53.6）	26（70.3）
大肠埃希菌（株）	163	13	207	25	204	25	194	23	277	16
ESBL-eco[n（%）]	88（54.0）	8（61.5）	111（53.6）	15（60.0）	98（48.0）	16（64.0）	98（50.5）	14（60.9）	118（42.6）	12（75.0）
肺炎克雷伯菌（株）	213	42	240	43	339	101	280	89	303	102
ESBL-kpn[n（%）]	41（19.3）	16（38.1）	61（25.4）	18（41.8）	97（28.6）	51（50.5）	87（31.1）	46（51.7）	104（34.3）	61（59.8）
肠杆菌目细菌（株）	407	89	600	88	775	184	650	167	758	159
CRE[n（%）]	10（2.5）	8（9.0）	34（5.7）	16（18.2）	80（10.3）	53（28.8）	68（10.5）	49（29.3）	80（10.6）	52（32.7）
鲍曼不动杆菌（株）	132	47	158	78	162	60	131	53	142	80
CR-AB[n（%）]	45（34.1）	32（68.1）	100（63.3）	73（93.6）	73（45.1）	48（80.0）	56（42.8）	39（73.6）	90（63.4）	70（87.5）
铜绿假单胞菌（株）	92	22	106	25	125	33	127	50	155	56
CR-PA[n（%）]	14（15.2）	6（27.3）	12（11.3）	2（8.0）	26（20.8）	16（48.5）	29（22.8）	17（34.0）	32（20.7）	26（46.4）

药物	CRE（n=272株）		CR-AB（n=364株）		CR-PA（n=113株）
药物	敏感率（%）	耐药率（%）	敏感率（%）	耐药率（%）	敏感率（%）	耐药率（%）
庆大霉素	23.9	72.1	9.5	86.6	54.2	38.3
阿米卡星	44.5	54.4	67.6	28.8	68.1	23.5
妥布霉素	17.3	77.6	16.1	82.7	60.2	38.1
环丙沙星	6.6	91.9	3.3	96.7	45.0	45.0
左氧氟沙星	8.1	90.8	4.8	73.5	50.0	40.0
磷霉素	14.0	72.7	-	-	26.4	61.3
头孢曲松	1.5	98.5	0	95.5	-	-
头孢他啶	4.0	95.6	3.9	95.5	50.0	40.0
头孢吡肟	11.0	85.3	3.6	96.4	47.9	40.3
哌拉西林-他唑巴坦	4.2	91.6	5.4	78.2	39.7	21.6
头孢哌酮-舒巴坦	1.8	95.2	11.4	44.1	35.0	37.5
氨曲南	6.6	98.5	-	-	1.2	98.2
亚胺培南	0	100	0	100	0	100
美罗培南	1.9	97.4	5	93.8	5.9	88.1
厄他培南	6.3	93.7	-	-	-	-

细菌种类	KPC酶（n=81株）	NDM酶（n=5株）	IMP酶（n=1株）	NDM+IMP复合酶（n=2株）
肺炎克雷伯菌（n=76株）	75	1	0	0
霍尔姆肠杆菌（n=2株）	0	1	1	0
产气克雷伯菌（n=3株）^*	2	0	0	0
弗劳地柠檬酸杆菌（n=2株）	0	0	0	2
黏质沙雷菌（n=4株）	4	0	0	0
产酸克雷伯菌（n=1株）	0	1	0	0
大肠埃希菌（n=1株）	0	1	0	0
阴沟肠杆菌（n=1株）	0	1	0	0