目的 探讨2019—2021年天津市宝坻区人民医院住院患者多重耐药菌（MDRO）检出及耐药分析，为临床抗菌药物的合理应用提供依据。方法 收集2019年1月—2021年12月天津市宝坻区人民医院住院患者送检标本分离的MDRO，排除同一患者同一部位分离的重复菌株。采用法国生物梅里埃公司VITEK-2 Compact型全自动微生物鉴定与药敏分析仪进行病原菌鉴定和药敏试验。对临床使用的3类或3类以上抗菌药物同时呈现耐药的细菌定义为MDRO并进行耐药分析。结果 检出多重耐药菌1 083株，其中产超广谱β-内酰胺酶（ESBLs）大肠埃希菌645株（59.56%）、产ESBLs肺炎克雷伯菌144株（13.3%）、多重耐药鲍曼不动杆菌（MDRAB）140株（12.93%）、耐甲氧西林金黄色葡萄球菌（MRSA）79株（7.29%）、多重耐药铜绿假单胞菌（MDRPA）54株（4.99%）、耐碳青霉烯的肠杆菌（CRE）21株（1.94%）。2019—2021年，MDRAB、MDRPA和CRE的检出率比较差异有统计学意义（P＜0.05）；组间比较，MDRAB的检出率2021年高于2020年（P＜0.05），MDRPA和CRE的检出率2021年高于2019年（P＜0.05）。标本主要来源于痰液、尿液、分泌物，占比分别为37.12%，23.45%，18.01%。3年间检出MDRO最高的科室为ICU，共167株（15.42%）。产ESBLs大肠埃希菌对氨苄西林、头孢唑林、头孢曲松、头孢呋辛钠、哌拉西林的耐药率较高，均在90%以上，对美罗培南、亚胺培南、阿米卡星、头孢替坦、哌拉西林/他唑巴坦敏感，敏感率在90%以上；产ESBLs肺炎克雷伯菌对氨苄西林、头孢呋辛钠、头孢曲松、哌拉西林的耐药率较高，均在90%以上，对美罗培南、亚胺培南、头孢替坦和阿米卡星敏感，敏感率在90%以上；MDRAB仅对阿米卡星较敏感，敏感率在90%以上，对大部分抗菌药耐药率均较高；MDRPA对阿米卡星的敏感率为50%，对大部分抗菌药耐药率均较高。MRSA对利福平、复方新诺明、庆大霉素、环丙沙星、左氧氟沙星、莫西沙星的耐药率在10%～20%，尚未发现对万古霉素、利奈唑胺、替加环素耐药的菌株。结论 天津市宝坻区人民医院分离的MDRO对抗菌药物有不同程度的耐药，加强病原学检查及耐药监测有助于临床合理选择抗菌药的种类和剂量，减少多重耐药菌的发生。

Objective To investigate the detection and analysis of multiple drug-resistant bacteria in hospitalized patients of Baodi District People's Hospital of Tianjin from 2019 to 2021, and to provide basis for rational clinical application of antibiotics. Results MDRO isolated from hospitalized patients in Baodi District People's Hospital of Tianjin from January 2019 to December 2021 was collected, and repeated strains isolated from the same patient at the same site were excluded. Vitek-2 Compact automatic microbiological identification and drug sensitivity analyzer from French Bio-Meriere company was used for pathogen identification and drug sensitivity test. Bacteria with concurrent resistance to three or more classes of antibiotics in clinical use were defined as MDRO and analyzed for resistance. 1 083 strains of multidrug-resistant bacteria were detected. Among them, ESBLs-Escherichia coli were 645 (59.56%), ESBLs-Klebsiella pneumoniae were 144 strains (13.3%), MDRAB were 140 strains (12.93%), MRSA were 79 strains (7.29%), MDRPA were 54 strains (4.99%), and CRE 21 strains (1.94%).From 2019 to 2021, the detection rates of MDRAB, MDRPA, and CRE were significantly different (P < 0.05). The detection rate of MDRAB in 2021 was higher than that in 2020 (P < 0.05), and the detection rate of MDRPA and CRE in 2021 was higher than that in 2019 (P < 0.05). The samples were mainly from sputum, urine, and secretions, accounting for 37.12%, 23.45% and 18.01%, respectively. The highest incidence of MDRO was found in ICU, with 167 strains (15.42%). ESBLs-Escherichia coli had high drug resistance rate to ampicillin, cefazolin, ceftriaxone, cefuroxime sodium, and piperacillin, all above 90%, and was sensitive to meropenem, imipenem, amikacin, cefotetan, piperacillin/tazobactam, the sensitivity rate was above 90%. ESBLs-Klebsiella pneumoniae had high drug resistance rate to ampicillin, cefuroxime sodium, ceftriaxone, and piperacillin, all above 90%, and was sensitive to meropenem, imipenem, ceftetan, and amicacin, the sensitivity rate was above 90%. MDRAB was only sensitive to amikacin, the sensitivity rate was more than 90%, and the resistance rate to most antibacterial drugs was high. The sensitivity rate of MDRPA to amikacin was 50%, and the resistance rate to most antibacterial drugs was high. The drug resistance rate of MRSA to rifampicin, cotrimoxazole, gentamicin, ciprofloxacin, levofloxacin and moxifloxacin ranged from 10% to 20%, but no resistant strains to vancomycin, linezolid and tigecycline were found. Conclusion MDRO isolated from Baodi District People's Hospital of Tianjin has different degrees of drug resistance to antibacterial drugs. Strengthening pathogenic examination and drug resistance monitoring is helpful to rationally select the type and dose of antibacterial drugs and reduce the occurrence of multiple drug resistance bacteria.

R978.1

天津市卫生信息学会科研项目(TJHIA-2020-001)