肝胆胰外科重症病房肠球菌耐药率变迁及中外数据库对比  

Changes of drug resistance rate of Enterococci in intensive care unit of hepatobiliary and pancreatic surgery department and comparative study of Chinese and foreign databases

作　　者：王雪飞[1] 赵永生[1] 赵庆华[1] 任为正[1] 何蕾[1] WANG Xue-fei;ZHAO Yong-sheng;ZHAO Qing-hua;REN Wei-zheng;HE Lei(The First Medical Center of Chinese PLA General Hospital,Institute of Hepatobiliary Surgery of Chinese PLA,Key Laboratory of Digital Hepetobiliary Surgery,PLA,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肝胆胰外科医学部重症医学科,解放军肝胆外科研究所,全军数字肝胆外科重点实验室,北京100853

出　　处：《中华医院感染学杂志》2022年第22期3429-3433,共5页Chinese Journal of Nosocomiology

基　　金：国家科技部科技创新2030新一代人工智能重大项目(2021ZD0140408)。

摘　　要：目的研究对比解放军总医院第一医学中心肝胆胰外科重症监护病房(简称为“HPB-SICU”)和美国重症监护医疗信息库第IV版(MIMIC-IV)中肠球菌检出情况和耐药率。方法回顾性分析2011-2020年HPB-SICU和2008-2019年MIMIC-IV中ICU患者临床资料,筛选提取其中肠球菌分离培养和药敏试验数据,对比分析肠球菌菌株数、来源和耐药变化情况。结果HPB-SICU共检出肠球菌705株,多重耐药菌163株,主要来自胆汁、腹腔引流液和血液。MIMIC-IV共检出肠球菌1104株,多重耐药菌276株,主要来自呼吸道、尿液和血液标本。两组数据均显示肠球菌对利奈唑胺的耐药率最低,MIMIC-IV中肠球菌对万古霉素耐药率高于HPB-SICU(P<0.05)。HPB-SICU中粪肠球菌对万古霉素和利奈唑胺保持高度敏感,近五年未检出耐万古霉素粪肠球菌,共检出耐利奈唑胺粪肠球菌5株;屎肠球菌对万古霉素和利奈唑胺也保持高度敏感,虽然近五年对万古霉素耐药率略有上升,但无统计学差异,近五年未检出耐利奈唑胺屎肠球菌。近十年HPB-SICU中肠球菌对替加环素耐药率接近100%。结论近10年HPB-SICU肠球菌耐药性有下降趋势,肠球菌对万古霉素的耐药率低于MIMIC-IV,有利奈唑胺耐药肠球菌检出。OBJECTIVE To observe and compare the isolation rates and drug resistance rates of Enterococci in the Intensive Care Unit of Hepato-Pancreato-Biliary Surgery of the First Medical Center of Chinese PLA General Hospital(referred to as"HPB-SICU")and the Medical Information Mart for Intensive Care IV(MIMIC-IV).METHODS The clinical data of patients in HPB-SICU from 2011 to 2020 and in MIMIC-IV from 2008 to 2019 were retrospectively analyzed.The data of isolated Enterococci and drug susceptibility testing were screened out and extracted;the number of Enterococci strains,specimen sources and changes of drug resistance rates were observed and compared.RESULTS A total of 705 strains of Enterococci and 163 strains of multidrug-resistant organisms were isolated from HPB-SICU,the strains were mainly isolated from bile specimens,peritoneal drainage fluid specimens and blood specimens.Totally 1104 strains of Enterococci and 276 strains of multidrug-resistant organisms were isolated from MIMIC-IV,and the strains were mainly isolated from respiratory tract specimens,urine specimens and blood specimens.The data of both groups showed that the drug resistance rate of Enterococci to linezolid was the lowest,the drug resistance rate of the Enterococci strains isolated from MIMIC-IV to vancomycin was higher than that of the strains isolated from HPB-SICU(P<0.05).Enterococcus faecalis strains isolated from HPB-SICU maintained highly sensitivity to vancomycin and linezolid,vancomycin-resistant E.faecalis has not been detected in the recent five years,and totally 5 strains of linezolid-resistant E.faecalis have been isolated;E.faecium strains also maintained high sensitivity to vancomycin and linezolid,although the drug resistance rate to vancomycin was slightly increased in the recent five years,there was no significant difference,linezolid-resistant E.faecium has not been detected in the recent five years.The drug resistance rate of Enterococci strains isolated from HPB-SICU to tigecycline was close to 100%in the recent ten years.CONCLU

关 键 词：医院感染 美国重症监护医疗信息库 革兰阳性球菌 重症医学 耐万古霉素肠球菌 

分 类 号：R378.1[医药卫生—病原生物学]