20212023年上海市某三级哨点医院住院患者多重耐药菌临床感染特征分析

Analysis of clinical infection characteristics of multidrug-resistant organisms in hospitalized patients in a tertiary sentinel hospital in Shanghai from 2021 to 2023

  • 摘要:
    目的 了解上海市某三级哨点医院住院患者多重耐药菌(MDROs)的感染特征,为制定针对性的预防和控制措施提供依据。
    方法 收集2021—2023年上海市某医院部分住院患者的MDROs菌株和相应的患者病案信息,并分析住院患者的基本情况、临床治疗、基础疾病及样本采集来源等资料。
    结果 2021—2023年共收集该医院分离的住院患者MDROs菌株134株,其中耐甲氧西林金黄色葡萄球菌(MRSA)菌株63株,耐碳青霉烯鲍曼不动杆菌(CRAB)菌株57株,耐碳青霉烯类肺炎克雷伯菌(CRKP)菌株14株。2021年30株,2022年47株,2023年57株。患者男女比为2.05∶1,60~<90岁年龄段占比最高(70.90%),原发诊断以呼吸系统疾病为主,感染部位以肺部和呼吸道为主。不同性别人群及感染部位的菌种分布差异无统计学意义(P>0.05),不同年龄人群及原发诊断的菌种分布差异有统计学意义(P<0.05)。入住重症监护病房(ICU)、有泌尿道插管、无动静脉插管、未使用呼吸机、未使用免疫抑制剂或激素、未接受放射治疗或化学治疗者占多数。是否接受放射治疗或化学治疗的菌种分布差异无统计学意义(P>0.05),是否有ICU入住史、有无泌尿道插管、有无动静脉插管、是否使用呼吸机、是否使用免疫抑制剂或激素的菌种分布差异均有统计学意义(均P<0.05)。标本类型主要为痰,所住病房以综合性ICU为主,采样时间以第一季度为主,基础疾病数以1~2种为主,使用抗菌药物≥4种者居多,近期未手术者居多。不同标本类型、所住病房及是否有ICU入住史的菌种分布差异均有统计学意义(均P<0.05),不同采样时间、基础疾病数及使用抗菌药物种类的菌种分布差异无统计学意义(P>0.05)。
    结论 该医院MDROs的预防控制形势依然严峻,应重点关注高危因素,加强感染监控和预防措施,以降低MDROs感染的发生率。

     

    Abstract:
    Objective To understand the infection characteristics of multidrug-resistant organisms (MDROs) in hospitalized patients in a tertiary sentinel hospital in Shanghai, so as to provide an evidence for the development of targeted prevention and control measures.
    Methods Data of MDROs strains and corresponding medical records of some hospitalized patients in a hospital in Shanghai from 2021 to 2023 were collected, together with an analysis of the basic information, clinical treatment, underlying diseases and sources of sample collection.
    Results A total of 134 strains of MDROs isolated from hospitalized patients in this hospital were collected from 2021 to 2023, including 63 strains of methicillin-resistant Staphylococcus aureus (MRSA), 57 strains of carbapenem-resistant Acinetobacter baumannii (CRAB), and 14 strains of carbapenem-resistant Klebsiella pneumoniae (CRKP). Of the 134 strains, 30 strains were found in 2021, 47 strains in 2022 and 57 strains in 2023. The male-to-female ratio of patients was 2.05∶1, with the highest percentage (70.90%) in the age group of 60‒<90 years. The primary diagnosis was mainly respiratory disease, with lung and respiratory tract as the cheif infection sites. There was no statistically significant difference in the distribution of strains between different genders and infection sites (P>0.05). However, the differences in the distribution of strains between different ages and primary diagnosis were statistically significant (P<0.05). Patients who were admitted to the intensive care unit (ICU), had urinary tract intubation, were not artery or vein intubated, were not on a ventilator, were not using immunosuppresants or hormones, and were not applying radiotherapy or chemotherapy were in the majority. There was no statistically significant difference in the distribution of strains for whether received radiotherapy or chemotherapy or not (P>0.05), while the differences in the distribution of strains with ICU admission history, urinary tract intubation, artery or vein intubation, ventilator use, and immunosuppresants or hormones use or not were statistically significant (all P<0.05). The type of specimen was mainly sputum, the hospitalized ward was mainly comprehensive ICU, the sampling time was mainly in the first quarter throughout the year, the number of underlying diseases was mainly between 1 to 2 kinds, the application of antibiotics ≥4 kinds, and those who didn’t receive any surgery recently accounted for the most. There were statistically significant differences in the distribution of strains between different specimen types, wards occupied and history of ICU stay (P<0.05), but no statistically significant difference in the distribution of strains between different sampling times, number of underlying diseases and types of antibiotics applied (P>0.05).
    Conclusion The situation of prevention and control on MDROs in this hospital is still serious. Focus should be placed on high-risk factors’ and infection monitoring and preventive measures should be strengthened to reduce the incidence rate of MDROs infection.

     

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