新冠疫情前后PICU细菌变迁及耐药性变化研究  

Study on Changes of Bacterial Spectrum and Drug Resistancein PICU Before and After COVID-19 Pandemic

作　　者：朱永冰 付丽娜[1] 陈中举 黄浩[1] 刘铜林[1] 陈瑜[1] Zhu Yongbing;Fu Lina;ChenZhongju(Department of Pediatric Intensive Care Unit,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Laboratory Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院儿童重症医学科,武汉430030 [2]华中科技大学同济医学院附属同济医院检验科,武汉430030

出　　处：《华中科技大学学报（医学版）》2023年第2期233-238,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省病理生理学会科研项目(No.2021HBAP004)。

摘　　要：目的探讨新冠疫情发生前后儿童重症监护病房(PICU)临床分离病原菌的特点及其耐药性的变迁,为后疫情时期合理使用抗生素、减少细菌耐药提供依据。方法采用回顾性研究方法对2017年1月1日至2019年12月1日(新冠疫情前组)、2020年1月1日至2022年12月1日(新冠疫情后组)华中科技大学同济医学院附属同济医院PICU所有送检标本中分离出的病原菌及常见病原菌药敏结果进行统计学分析。结果2017~2022年近6年时间,该院PICU共分离出789株菌株,其中新冠疫情前组占比51.7%,新冠疫情后组占比48.3%,均以革兰阴性菌为主。新冠疫情后组中流感嗜血杆菌、鲍曼不动杆菌和肺炎链球菌占比均明显下降,铜绿假单胞菌占比较前上升,由4.4%升至10.5%,差异均具有统计学意义(均P<0.05)。在细菌耐药性方面,新冠疫情后组鲍曼不动杆菌对除氨曲南、替加环素外的多种药物的耐药率均下降(均P<0.05);铜绿假单胞菌在疫情前后对氨基糖苷类、大环内酯类、喹诺酮类等药物的耐药率差异无统计学意义(均P>0.05)。新冠疫情后金黄色葡萄球菌对头孢类药物的耐药率较前升高,对红霉素、克林霉素的耐药率较前下降(均P<0.05)。在常见的多重耐药细菌方面,除耐甲氧西林金黄色葡萄球菌(MRSA)外,常见多种多重耐药菌占比较前均呈下降趋势,其中耐碳青霉烯类鲍曼不动杆菌由68.4%下降至33.3%,差异具有统计学意义(P<0.01)。结论新冠疫情后PICU分离细菌谱及细菌耐药性较前发生了较大变化,流感嗜血杆菌、鲍曼不动杆菌和肺炎链球菌占比较前下降,铜绿假单胞菌占比较前上升。新冠疫情后常见多种多重耐药的菌株占比较前下降,而MRSA占比较前略有升高,需引起重视。Objective To explore the changes of clinical pathogenic bacteria isolated from pediatric intensive care unit(PICU)before and after the outbreak of COVID 19,and to provide evidence for rational use of antibiotics and reduction of bacterial drug resistance in the post-epidemic period.Methods A retrospective study was conducted to statistically analyze the bacteria and drug senstivity results of common pathogens isolated from all specimens sent by the PICU of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology before pandemic(from January lst of 2017 to December lst of 2019)and after pandemic(from January lst of 2020 to December 1st of 2022).Results In the past six years(from 2017 tc 2022),a total of 789 strains were identified from PICU specimens.Among the specimens,the pre pandemic group accounted for 51.7%,and the post-pandemic group accounted for 48.3%.Strains from both groups were primarily Gram-negative bacteria.Proportions of Haemo philus influenzae、Acinetobacter baumarnii、and Stre ptococcus pneumoniae decreased in post pandemic group(all P<0.05),whereas prevalence of Pseudomonas aeruginosa increased from 4.4%to 10.5%(P<0.05).The drug resistance rates of Acinetobacter baumarnii to various drugs decreased in post-pandemic group,except for aztreonam and tigecycline(P<0.05).There was no significant difference in the resistance rate of Pseudomonas aeruginosa strain to aminoglycosides,macrolides and quinolones(all P>0.05).Resistance rate of Sta ph ylococcus aureus to cephalosporins increased,but its resistance rate to erythromycin and clindamycin decreased in post pandemic group(all P<0.05).Except for methicillin resistant Sta phylococcus aureus(MRSA),the proportion of common multi-drug resistant bacteria decreased compared to pre-pandemic group,and proportion of carbapenem-resistant Acinetobacter baumarnii decreased from 68.4%to 33.3%(P<0.01).Conclusion After the COVID-19 epidemic,the bacterial composition and drug resistance in PICU changed significantly.Proportions of Haemop

关 键 词：新冠疫情 儿童重症监护病房 细菌变迁 耐药性 

分 类 号：R446.5[医药卫生—诊断学]