2017—2020年柳州某医院血流感染病原菌变迁及耐药性分析  

The Epidemiology of Bacteria Separated from Blood Cultures and Antimicrobial Resistance Patterns in a Hospital from 2017 to 2020 in Liuzhou

作　　者：罗国兰[1] 李梦薇[1] 朱虹贞[1] 韦柳华[1] Luo Guo-lan;Li Meng-wei;Zhu Hong-zhen;Wei Liu-hua(The Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou 545005)

机构地区：[1]广西医科大学第四附属医院,广西柳州545005

出　　处：《国外医药（抗生素分册）》2022年第4期267-271,共5页World Notes on Antibiotics

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20210030);广西壮族自治区卫生健康委员会自筹经费科研课题(Z20200152)。

摘　　要：目的 分析连续4年的血流感染(Bloodstream infection, BSI)的病原菌分布及主要病原菌耐药性,为BSI的经验性治疗和院内感染防控提供参考依据。方法 回顾分析我院2017年1月至2020年12月分离的血培养阳性的标本,对病原菌的构成及主要病原菌的药敏进行分析,采用Whonet 5.6软件进行耐药统计分析。结果 2017—2020年共检出病原菌2 473株,主要来自重症医学科、普外科和肾内科等,其中革兰阳性菌544株(占22.0%),革兰阴性菌1 786株(72.2%)。前3位分离菌为大肠埃希菌942株(38.1%),肺炎克雷伯菌373株(15.1%),金黄色葡萄球菌214株(8.7%)。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)检出率分别为40%和20%左右。大肠埃希菌在2017—2018年有3例碳青霉烯类耐药,2019—2020年无碳青霉烯类耐药。肺炎克雷伯菌在2019年有1例碳青霉烯类耐药,其余3年无碳青霉烯类耐药。金黄色葡萄球菌对万古霉素、利奈唑胺、奎奴普丁/达福普汀和替加环素均为敏感,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为20%左右。结论 通过连续4年的数据分析显示,我院BSI以革兰阴性菌为主,革兰阳性菌有下降趋势。主要分离菌对临床常用抗菌药物耐药性相对稳定,特别说明,大肠埃希菌和肺炎克雷伯菌产ESBLs检出率明显低于不同地区三甲医院,应密切关注本地区的血流感染常见菌群的分布及耐药性的动态性改变,为BSI经验性治疗和院感防控提供参考。Objective To analyze the distribution of pathogenic bacteria and drug resistance of major pathogens in bloodstream infection (BSI) of 4 consecutive years for reasonable control of BSI and nosocomial infection.Methods The blood culture positive samples isolated in our hospital from January 2017 to December 2020 were retrospectively analyzed.The composition of pathogens and the drug sensitivity data of main pathogens were analyzed by WHONET 5.6 software.Results A total of 2473 strains were detected from 2017 to 2020,including 544 Gram-positive bacteria (22.0%) and 1786 Gram-negative bacteria (72.2%).The patients mainly came from the department of intensive care unit,general surgery and nephrology.The most frequetly isolates were Escherichia coli (942 strains,38.1%),Klebsiella pneumoniae (373 strains,15.1%) and Staphylococcus aureus (214 strains,8.7%).The detection rates of ESBLs of Escherichia coli and Klebsiella pneumoniae were about 40.0% and 20.0%,respectively.There was 3 cases of carbapenem resistance from 2017 to 2018 and no carbapenem resistance from 2019 to 2020 in Escherichia coli.There was 1 cases of carbapenem resistance in 2019 and no carbapenem resistance in the other 3 years in Klebsiella pneumoniae.Staphylococcus aureus was sensitive to vancomycin,linezolid,quinuptine / daprotine and tegacyclin,and methicillin resistant Staphylococcus aureus (MRSA) was about 20%.Conclusion The data analysis for four consecutive years showed that the BSI in our hospital was mainly Gram-negative bacteria,and the Gram-positive bacteria showed an downward trend.The drug resistance of the main isolates to commonly used antibiotics is relatively stable.However,the detection rate of ESBLs produced by Escherichia coli and Klebsiella pneumoniae is significantly lower than that in the third class hospitals in different regions.We should pay close attention to the distribution of common flora of blood flow infection and the dynamic change of drug resistance in this region,so as to provide reference for empirical treatment of BSI

关 键 词：血流感染 血培养 病原菌 耐药性 

分 类 号：R978[医药卫生—药品]