2018-2020年多中心血流感染分离菌分布及耐药性分析  

Distribution and drug resistance analysis of bacteria from bloodstream infection of multicenters from 2018 to 2020

作　　者：孟雪斐 张鸿娟[1] 马志刚 冀旭峰[2] 刘平娟 喻华[4] 蓝锴[5] 季萍[6] 贾伟[7] 李刚[7] 刘家云 谢小芳[9] 鲍春梅 耿荣华[11] 曲芬 单斌[1] Meng Xue-fei;Zhang Hong-juan;Ma Zhi-gang;Ji Xu-feng;Liu Ping-juan;Yu Hua;Lan Kai;Ji Ping;Jia Wei;Li Gang;Liu Jia-yun;Xie Xiao-fang;Bao Chun-mei;Geng Rong-hua;Qu fen;Shan Bin(The First Affiliated Hospital,Kunming Medical University,Yunnan Provincial Clinical Research Center for Laboratory Medicine,Kunming 650032;The First Hospital of Jilin University,Changchun 130000;The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080;Sichuan Provincial People's Hospital,Chengdu 610072;Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120;The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054;General Hospital of Ningxia Medical University,Yinchuan 750004;The First Affiliated Hospital of Air Force Medical University,Xi'an 710032;The Second Affiliated Hospital of Soochow University,Suzhou 215004;The Fifth Medical Center of PLA General Hospital,Beijing 100039;General Aviation Hospital,Beijing 100012)

机构地区：[1]昆明医科大学第一附属医院云南省医学检验临床医学研究中心,昆明650032 [2]吉林大学第一医院,长春130000 [3]中山大学附属第一医院,广州510080 [4]四川省人民医院,成都610072 [5]广东省中医院,广州510120 [6]新疆医科大学第一附属医院,乌鲁木齐830054 [7]宁夏医科大学总医院,银川750004 [8]空军军医大学第一附属医院,西安710032 [9]苏州大学附属第二医院,苏州215004 [10]解放军总医院第五医学中心,北京100039 [11]航空总医院,北京100012

出　　处：《中国抗生素杂志》2021年第11期985-993,共9页Chinese Journal of Antibiotics

基　　金：国家科技基础资源调查专项(No.2019FY101200和No.2019FY101209);国家自然科学基金(No.81460322)。

摘　　要：目的分析2018-2020年多中心血流感染病原菌的分布及耐药演变特点,为临床合理选用抗菌药物提供可靠依据。方法采用药敏纸片法或仪器法,对11所三级医院按统一技术方案,进行细菌鉴定及药物敏感性试验,按2020年CLSI折点标准判断结果,数据分析使用WHONET5.6。结果11所三级医院3年血流感染标本共分离病原菌20742株,其中革兰阴性菌12399株(59.8%),革兰阳性菌8343株(40.2%);排名前3的依次为大肠埃希菌(5231株,25.2%)、肺炎克雷伯菌(2840株,13.7%)、表皮葡萄球菌(1517株,7.3%)。3年药敏结果表明,大肠埃希菌对环丙沙星的耐药率均高于60.0%(62.8%、63.6%和66.3%);肺炎克雷伯菌对碳青霉烯类耐药率逐年上升(16.7%、16.8%和21.6%),其中空军军医大学第一附属医院、昆明医科大学第一附属医院最高36.2%和30.6%;MRSA检出率逐年下降(32%、31.6%和30.7%);非发酵革兰阴性杆菌铜绿假单胞菌对哌拉西林/他唑巴坦的耐药率分别为10.2%、10.5%和7.5%;鲍曼不动杆菌对碳青霉烯类抗菌药物的耐药率较高(77.6%、76.7%和74.7%);屎肠球菌检出率高于粪肠球菌,除利奈唑胺和四环素外,屎肠球菌的耐药性均高于粪肠球菌;布鲁菌共检出300株,其中宁夏医科大学总医院检出最多(165株)。结论11所医院血流感染病原菌3年检出及构成变化不大,以革兰阴性菌为主,大肠埃希菌和肺炎克雷伯菌占绝对优势;大肠埃希菌对喹诺酮类耐药率较高;鲍曼不动杆菌耐药情况严重;布鲁菌所有成员单位均有检出,宁夏医科大学总医院检出数最多。临床应持续加强细菌耐药监测以指导临床合理用药。Objective To investigate the distribution and antimicrobial resistance evolution characteristics of multicenter bloodstream infection pathogens from 2018 to 2020 so as to provide guidance for reasonable clinical use of antimicrobial agents.Methods The Kirby-Bauer method or the instrument method was used to conduct bacterial identification and antibiotics susceptibility test in accordance with the unified technical plan.The result of antibiotics susceptibility test was defined according to the criteria of CLSI 2020,and the data were analyzed by WHONET5.6 software.Results A total of 20,742 strains of pathogenic bacteria were isolated from blood specimens from 11 tertiary A hospitals in three years,including 12,399 strains(59.8%)of Gram-negative bacteria and 8,343 strains(40.2%)of Gram-positive bacteria.The top 3 pathogens were Escherichia coli(5,231 strains,25.2%),Klebsiella pneumoniae(2,840 strains,13.7%),and Staphylococcus epidermidis(1,517 strains,7.3%).Resistance rate of Escherichia coli to ciprofloxacin was relatively high(62.8%,63.6%,66.3%).Resistance rate of Klebsiella pneumoniae to carbapenems increased year by year(16.7%,16.8%,21.6%),among which the First Affiliated Hospital of Air Force Medical University and the First Affiliated Hospital of Kunming Medical University havd the highest antimicrobial resistance rates(36.2%,30.6%).The detection rate of MRSA is decreasing year by year(32%,31.6%,30.7%).Among non-fermenting sugar Gram-negative bacteria,the resistance rates of Pseudomonas aeruginosa to piperacillin/tazobactam were 10.2%,10.5%,and 7.5%.Acinetobacter baumanii had a higher resistance rate to carbapenem antimicrobials(77.6%,76.7%,74.7%).The detection rate of Enterococcus faecium was higher than Enterococcus faecalis,and the resistance rates of Enterococcus faecium except for linezolid and tetracycline were higher than those of Enterococcus faecalis.A total of 300 strains of Brucella were detected,the most being from General Hospital of Ningxia Medical University(165 strains).Conclusion The detection

关 键 词：血流感染 病原菌 耐药性 碳青霉烯类耐药 细菌耐药监测 

分 类 号：R987.1[医药卫生—药品]