Khảo sát tình hình đề kháng kháng sinh của trực khuẩn Gram âm tại Bệnh viện An Sinh trong 6 năm (2017

Khảo sát tình hình đề kháng kháng sinh của trực khuẩn Gram âm tại Bệnh viện An Sinh trong 6 năm (2017 - 2022)

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Tác giả: Quốc Thu Vân Lê, Văn Nhật Tú Lê, Văn Điển Mai, Thị Bích Yến Nguyễn, Ngọc Quang Võ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2024

Mô tả vật lý: tr.199

Bộ sưu tập: Báo, Tạp chí

ID: 443705

Thêm vào giỏ Liên kết toàn văn

Các trực khuẩn Gram âm (Gram Negative Bacilli-GNB) như nhóm vi khuẩn đường ruột Enterobacteriacae (Echerichia coli, Proteus, Klebsiella, Citrobacter, Enterrobacter & Serratia species), nhóm Pseudomonas aeruginosa và nhóm Acinetobacter có tỷ lệ cao đề kháng nhiều kháng sinh. Khảo sát tình hình GNB đề kháng kháng sinh tại bệnh viện An Sinh giúp bác sĩ chọn lựa kháng sinh phù hợp. Trong 6 năm (2017 - 2022) có 4097 mẫu bệnh phẩm của bệnh nhân BV An Sinh được cấy vi sinh, phát hiện 1151 chủng vi khuẩn (28.1%), trong đó GNB chiếm 63.8% (734 chủng), tăng từ 53.2% (2017) lên 68.8% (2022). Vi khuẩn NGB thường gặp nhất vẫn là E. coli (415 chủng, 56.7%), sau đó là Klebsiella spp. (107 chủng, 14.6%) và Pseudomonas spp. (97 chủng, 13.3%). Các GNB khác chiếm tỷ lệ ít hơn. Có 263/607 chủng vi khuẩn đường ruột có men ESBL (43.3%). GNB đa kháng thuốc chiếm 57.4% (421/734 chủng). Trong số từng nhóm kháng thuốc được phân lập tại bệnh viện An Sinh, MDR-GNB chiếm 56.1% (366/652) trong số các chủng MDR. XDR-GNB chiếm 98% (48/49) các chủng vi khuẩn XDR, tăng đột biến vào năm 2022 (20/48 chủng). Vi khuẩn kháng hết tất cả các kháng sinh hiện có (PDR) bắt đầu xuất hiện từ năm 2020, tăng dần và tất cả 6 chủng PDR đều thuộc nhóm Klebsiella & Enterobacter. Tỷ lệ E. coli đa kháng thuốc là 70.6% (293/415), chủ yếu là MDR (278/415). Vi khuẩn nhóm Klebsiella có 45.8% (49/107 chủng) đa kháng, trong đó 30.8% MDR (33 chủng), 10.3% XDR (11 chủng) & 4.7% PDR (5 chủng). Nhóm Pseudomonas có tỷ lệ đa kháng chung là 30.9% (30/97 chủng), gồm 15.5 % MDR & 15.5% XDR. Nhóm Enterobacter có tỷ lệ đa kháng là 45.5% (25/55 chủng), với 40% MDR (22 chủng), 1.8% XDR & PDR là 3.6%. Nhóm Acinetobacter có tỷ lệ đa kháng chung là 44% (11/25 chủng), gồm 20% MDR & 24% XDR. Chỉ còn 7 kháng sinh còn nhạy cảm >
80% với vi khuẩn GNB gồm: Ampi/sulbactam (80.9%), Ticarcillin/clavulanic (82.9%), Piperacillin/tazobactam (86.8%), nhóm Carbapenem (88%), Cefoperazone/sulbactam (90.4%), Polymycin (91.7%) và Amikacin (92.1%). GNB có mức đề kháng với các nhóm kháng sinh khác từ 30 - 100%. Kết luận: Đa số vi khuẩn phân lập được ở bệnh viện An Sinh là GNB (63.8%). Tỷ lệ nhiễm GNB tăng dần 53.2% (2017) lên 68.8% (2022). Trong nhóm GNB, tỷ lệ cao nhất là E. coli (56.7%), sau đó là Klebsiella spp. (14.6%) và Pseudomonas spp. (13.3%). Tỷ lệ vi khuẩn đường ruột sinh men ESBL là 43.3%. GNB đa kháng, siêu kháng & kháng hết cũng gia tăng. Mức độ nhạy cảm với các kháng sinh của vi khuẩn GNB của bệnh nhân ở bệnh viện An Sinh giảm dần theo thời gian. Năm 2022 không còn kháng sinh nào còn nhạy 100% với trực khuẩn Gram âm nữa. Abstract Gram - negative bacilli (GNB) such as Enterobacteriacae (Echerichia coli, Proteus, Klebsiella, Citrobacter, Enterrobacter & Serratia sp), Pseudomonas and Acinetobacter groups have high antibiotic rates. Surveying the situation of antibiotic resistance in An Sinh hospital helps doctors choose appropriate antibiotics. In 6 years (2017 - 2022), 4097 samples from An Sinh Hospital’s patients were cultured, 1151 bacterial strains were detected (28.1%), of which GNB was 63.8% (734 germs), increased from 53.2% (2017) to 68.8% (2022). The most common NGB bacteria is still E. coli (415 strains, 56.7%), followed by Klebsiella spp. (107 strains, 14.6%) and Pseudomonas spp. (97 strains, 13.3%). Other GNB showed less ratio. There were 263/607 ESBL-producing Enterobacterales (43.3%). There are 3 types of multidrug resistance: Multi - drug resistant (MDR), Extensively drug resistant (XDR) and Pandrug - resistant (PDR). Among all multidrug resistance strains, GNB accounted for 57.4% (421/734 strains). MDR-GNB accounted for 56.1% (366/652) of the MDR strains. GNB accounts for 98% (48/49) of XDR bacterial strains, with a spike in 2022 (20/48 strains). Bacteria resistant to all available antibiotics began to appear in 2020 at An Sinh hospital, gradually increasing and we found all 6 PDR strains belong to the Klebsiella & Enterobacter spp. The rate of multidrug resistant E. coli was 70.6% (293/415), mainly MDR (278/415). Klebsiella bacteria have 45.8% (49/107 strains) multi-resistant, including 30.8% MDR (33 strains), 10.3% XDR (11 strains) & 4.7% PDR (5 strains). The Pseudomonas group has an overall multi-resistance rate of 30.9% (30/97 strains), including 15.5% MDR & 15.5% XDR. The Enterobacter group has a multi-resistance rate of 45.5% (25/55 strains), with 40% MDR (22 strains), 1.8% XDR & PDR of 3.6%. The Acinetobacter group has an overall multi-resistance rate of 44% (11/25 strains), including 20% MDR & 24% XDR. Only 7 antibiotics remain more than 80% sensitive to GNB bacteria including: Ampicilin/sulbactam (80.9%), Ticarcillin/clavulanic (82.9%), Piperacillin/tazobactam (86.8%), Carbapenem group (88%), Cefoperazone/ sulbactam (90.4%), Polymycin (91.7%) and Amikacin (92.1%). GNB has resistance levels to other antibiotic groups ranging from 30-100%. Conclusion: The majority of bacteria isolated at An Sinh hospital were GNB (63.8%). The GNB infection rate gradually increases from 53.2% (2017) to 68.8% (2022). In the GNB group, the highest rate was E. coli (56.7%), followed by Klebsiella spp. (14.6%) and Pseudomonas spp. (13.3%). The proportion of intestinal bacteria that produce ESBL enzymes is 43.3%. Multidrug-resistant, extensively drug-resistant and fully resistant GNB also increased. The sensitivity level to antibiotics of GNB of patients at An Sinh hospital gradually decreased over time. In 2022, there will no longer be any antibiotics that are 100% sensitive to Gram - negative bacilli. DOI: 10.59715/pntjmp.3.1.24

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