某教学医院2011-2021年血培养常见耐药菌临床分布及其药敏结果分析  

Clinical distribution of common drug-resistant bacteria occurred in the blood culture of a teaching hospital from 2011 to 2021 and its drug resistance results analysis

作　　者：丁子珊 刘智勇 唱凯 陈鸣 DING zishan;LIU zhiyong;CHANG kai;CHEN ming(Department of Clinical Laboratory,the First Affiliated Hospital of Army Military Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院检验科,重庆400038

出　　处：《国际检验医学杂志》2022年第19期2403-2410,共8页International Journal of Laboratory Medicine

基　　金：基于声流体及DNA四面体分子镊子的外泌体circRNA富集、检测技术及在肝癌中的应用(81972027)。

摘　　要：目的 研究该院近11年血培养分离的多重耐药菌(MDROS)的临床分布情况及其对常用抗菌药物的耐药性,旨在为院内防控及抗感染方案的选择提供指导。方法 收集2011年1月至2021年12月该院的住院患者血流感染临床送检标本分离菌株的临床资料,采用法国梅里埃公司的VITEK2 Compact全自动细菌鉴定和药敏系统对MDROS的临床分布特点及其交叉耐药情况进行统计分析。结果 (1)该院住院患者所送检血清标本中,共检出非重复病原菌14 918株,MDROS 4 081株,占27.4%。检出的病原菌排前5位的分别是大肠埃希菌(占21.4%)、鲍曼不动杆菌(占14.1%)、肺炎克雷伯菌(占8.9%)、金黄色葡萄球菌(占7.4%)和铜绿假单胞菌(占6.1%)。(2)药敏结果提示:超广谱β-内酰胺酶的大肠埃希菌(ESBL)对亚胺培南、厄他培南、阿米卡星敏感,耐药率在2011-2021年均<5.0%;对头孢呋辛、氨曲南、美罗培南的耐药率呈现逐年升高趋势;(3)泛耐药鲍曼不动杆菌(PDR-AB)耐药率最高,对头孢类抗菌药物的耐药率由2011年的70.0%~80.0%升高为2021年全耐药(100.0%);对米诺环素的耐药率由12.5%升高至30.5%,对替加环素较为敏感,耐药率为0.1%;(4)耐碳青酶烯类铜绿假单胞菌(CR-PAE)对替加环素、呋喃妥因、亚胺培南的耐药率由2011年的88.0%、78.0%、92.3%逐年升高到100.0%;(5)耐甲氧西林金黄色葡萄球菌(MRSA)对大环内酯类、头孢类、青霉素类抗菌药物的耐药率均在80.0%以上,年份间无明显变化趋势;对环丙沙星的耐药率由88.2%逐年降低至62.2%,对万古霉素、利奈唑胺敏感,未发现耐药菌株;(6)耐碳青酶烯类肺炎克雷伯菌(CR-KPN)对氨曲南、甲氧苄啶/复方磺胺甲噁唑、黏菌素的耐药率由77.2%、49.1%、4.0%升高至97.0%、83.9%、12.8%;对阿米卡星、左氧氟沙星的耐药率呈现逐年降低趋势。结论 由于严峻的细菌耐药形势及抗菌药物的广泛使用,使得该院MDROS检出率较高,耐药情况Objective The clinical distribution of multiple resistant bacteria(MDROS) isolated in blood culture in the past 11 years and its resistance to commonly used antimicrobial drugs were studied, aiming to provide guidance for the hospital prevention and control and the selection of anti-infection regimen.Methods The clinical data of isolates from the blood flow infection samples of hospitalized patients in the First Affiliated Hospital of Army Military Medical University from January 2011 to December 2021 were collected, and the clinical distribution and cross-drug resistance were analyzed by the VITEK2 Compact automatic bacterial identification and drug susceptibility system of Meriere of France.Results(1)Among the serum samples of hospitalized patients in the hospital, 14 918 non-repeat pathogens and 4 081 MDROS were detected, accounting for 27.4%.The top five pathogens detected were Escherichia coli(21.4%),Acinetobacter baumannii(14.1%),Klebsiella pneumoniae(8.9%),Staphylococcus aureus(7.4%) and Pseudomonas aeruginosa(6.1%).(2)The drug resistance results suggest that extended-spectrum β-lactamases-producing Escherichia coli(ESBL) was sensitive to imipenem, ertapenem and amikacin, and the resistance rate was less than 5.0% from 2011 to 2021;the resistance rate to cefuroxime, trantreonam and meropserm was increasing year by year;(3) Pan-resistant Acinetobacter baumannii(PDR-AB) had the highest resistance rate, resistance rate to cephalosporins increased from 70.0%-80.0% in 2011 to full resistance in 2021(100.0%);resistance rate to minocycline increased from 12.5% to 30.5%,and the resistance rate to tigecycline was 0.1%;(4)The resistance rate of carbapenem-resistant P.aeruginosa(CR-PAE) to tigecycline, nitrofurantoin and meropenem increased from 88.0%,78.0% and 92.3% in 2011 to 100.0%;(5)The resistance rates of methicillin-resistant Staphylococcus aureus(MRSA) to macrolide, cephalosporins, penicillin were all above 80.0%,with no obvious change trend between years;the resistance rate of ciprofloxacin decreased from 8

关 键 词：多重耐药菌 超广谱β-内酰胺酶的大肠埃希菌 泛耐药鲍曼不动杆菌 耐碳青酶烯类铜绿假单胞菌 耐碳青酶烯类肺炎克雷伯菌 耐甲氧西林金黄色葡萄球菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]