2011-2020年肝胆外科医院感染病原菌分布及其耐药性变迁  

Distribution and drug resistance of pathogenic bacteria isolated from hepatobiliary surgery department patients with nosocomial infection from 2011 to 2020

作　　者：孙丹[1] 李丹 索继江[1,3] 白艳玲 刘运喜[3] 杜明梅[3] SUN Dan;LI Dan;SUO Ji-jiang;BAI Yan-ling;LIU Yun-xi;DU Ming-mei(Hainan Hospital,Chinese PLA General Hospital,Sanya,Hainan 572014,China;不详)

机构地区：[1]解放军总医院海南医院疾病预防控制科,海南三亚572014 [2]解放军96604部队医院,甘肃兰州730000 [3]解放军总医院第一医学中心疾病预防控制科,北京100039

出　　处：《中华医院感染学杂志》2022年第24期3752-3757,共6页Chinese Journal of Nosocomiology

基　　金：国家重点研发计划基金资助项目(2017YFC0806308)。

摘　　要：目的明确肝胆外科发生医院感染主要病原菌分布及耐药性变迁,为指导肝胆外科合理选择抗菌药物治疗医院感染提供理论依据。方法收集2011-2020年某院肝胆外科发生医院感染住院患者临床资料,对不同医院感染类型检出的病原菌构成及主要病原菌的耐药性进行回顾性分析。结果2011-2020年肝胆外科共收容住院患者65001人次,医院感染患者3525例次,手术部位感染率最高(SSI)为首位(1.97%),其次为血流感染(BSI)(1.48%)和下呼吸道感染(0.81%)。共分离病原菌4551株,其中革兰阴性菌2796株(61.44%),革兰阳性菌1080株(23.73%),真菌675株(14.83%);革兰阴性菌检出以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和鲍氏不动杆菌为主。革兰阳性菌以屎肠球菌最常见。SSI和BSI感染首位致病菌是肺炎克雷伯菌,下呼吸道感染首位致病菌是鲍氏不动杆菌。近十年大肠埃希菌和铜绿假单胞菌检出量显示下降趋势(P<0.05)。肺炎克雷伯菌对亚胺培南耐药率由2011年的18.75%上升至2020年75.89%,呈明显上升趋势(P<0.001)。结论肝胆外科医院感染以SSI为主,不同感染部位致病菌不同,病原菌主要是革兰阴性杆菌,碳青霉烯耐药菌株多见,近十年肺炎克雷伯菌碳青霉烯耐药趋势逐年加重,应加强肝胆外科医院感染耐药菌的防控,合理选择抗菌药物。OBJECTIVE To explore the distribution and drug resistance changes of the main pathogenic bacteria related to nosocomial infection in Hepatobiliary Surgery,and to provide theoretical basis for the rational selection of antibiotics for the treatment of nosocomial infection in hepatobiliary surgery.METHODS Inpatients with nosocomial infection in the Department of Hepatobiliary Surgery in a hospital from 2011 to 2020 were recruited,the clinical data were collected,and the composition of pathogenic bacteria detected in different nosocomial infection types and drug resistance of main pathogenic bacteria were analyzed retrospectively.RESULTS From 2011 to 2020,total of 65001 inpatients were admitted to the Department of Hepatobiliary Surgery,and nosocomial infection occurred in 3525 patients.The highest incidence occurred in surgical site infection(SSI)(1.97%)followed by bloodstream infection(BSI)(1.48%)and lower respiratory tract infection(0.81%).A total of 4551 strains of bacteria were isolated,including 2796 strains(61.44%)of gram-negative bacteria,1080 strains(23.73%)of gram-positive bacteria and 675 strains(14.83%)of fungi.Gram-negative bacteria mainly included Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa and Acinetobacter baumannii.Enterococcus faecium was the most common gram-positive bacteria.K.pneumoniae was the primary pathogen in SSI and BSI infections,and A.baumannii was the primary pathogen in lower respiratory tract infection.The detection rates of E.coli and P.aeruginosa showed a downward trend in recent ten years(P<0.05).The drug-resistant rate of K.pneumoniae to imipenem increased from 18.75%in 2011 to 75.89%in 2020,showing a significant upward trend(P<0.001).CONCLUSION SSI is the main type of nosocomial infection in Hepatobiliary Surgery Department,and different infection sites have different pathogens.The main pathogens are Gram-negative bacteria,and carbapenem-resistant strains are common.The trend of carbapenem-resistant K.pneumoniae infection has been increasing year by year in the

关 键 词：细菌感染 抗菌药物 耐药性 病原菌 肝胆外科 医院感染 

分 类 号：R378[医药卫生—病原生物学]