2017-2021年热带地区医院感染细菌监测及耐药性  

Distribution characteristics and drug resistance changes of pathogenic bacteria of nosocomial infections in tropical zone from 2017 to 2021

作　　者：孙丹[1] 施施 杨金燕[1] 孙娜娜 夏婷婷 陈元斌 索继江[1,3] 宋明辉 SUN Dan;SHI Shi;YANG Jin-yan;SUN Na-na;XIA Ting-ting;CHEN Yuan-bin;SUO Ji-jiang;SONG Ming-hui(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]解放军总医院海南医院检验科,海南三亚572014 [3]解放军总医院第一医学中心疾病预防控制科,北京100039 [4]解放军总医院海南医院热带医学科,海南三亚572014

出　　处：《中华医院感染学杂志》2023年第7期1106-1111,共6页Chinese Journal of Nosocomiology

基　　金：海南省重点研发基金资助项目(ZDYF2021SHFZ262)。

摘　　要：目的了解2017-2021年医院感染病原菌分布及耐药性,以及特殊病原菌的检出情况,为指导合理选择抗菌药物提供理论依据。方法通过医院感染实时监控系统收集2017-2021年发生医院感染的住院患者,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。结果医院感染患者共有3004例次,其中以下呼吸道感染为首位(49.73%),其次为泌尿系统感染和血流感染。共分离病原菌2945株,其中革兰阴性菌60.31%,革兰阳性菌17.83%,真菌21.87%;革兰阴性菌检出以鲍氏不动杆菌、肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌为主。革兰阳性菌以金黄色葡萄球菌最常见。特殊菌群中产超广谱β-内酰胺酶(ESBL)大肠埃希菌检出率呈上升趋势,耐碳青霉烯类的铜绿假单胞菌(CRPA)和耐甲氧西林金黄色葡萄球菌(MRSA)检出率呈下降趋势,耐碳青霉烯类的鲍氏不动杆菌(CRAB)检出率无统计学意义。耐药性分析发现鲍氏不动杆菌耐药情况最严重,对不同种类抗菌药物耐药率均较高;肺炎克雷伯菌对亚胺培南和厄他培南耐药率相对降低。大肠埃希菌对第三/四代头孢菌素类药物耐药率均<30%。铜绿假单胞菌对青霉素类和头孢菌素类耐药率普遍很高,对环丙沙星、庆大霉素耐药性均<10%。结论医院感染细菌构成比主要以革兰阴性菌鲍氏不动杆菌为主,并且ESBL大肠埃希菌检出率高,耐药形势比较严峻,因此应加强院内感染耐药菌的防控,合理选择抗菌药物。OBJECTIVE To investigate the distribution,drug resistance and detection rates of the specific strains of pathogenic bacteria in nosocomial infections from 2017 to 2021,and to provide theoretical basis for rational use of antibiotics.METHODS The inpatients with nosocomial infection tracked by real-time monitoring system of nosocomial infection from 2017 to 2021 were enrolled.The composition of pathogenic bacteria detected in different nosocomial infection types and the drug resistance of main pathogenic bacteria were analyzed retrospectively.RESULTS There were 3004 cases of nosocomial infection,among which the following respiratory tract infection was the first(49.73%),followed by urinary system infection and bloodstream infection.A total of 2945 strains were isolated,including gram-negative bacteria(60.31%),gram-positive bacteria(17.83%)and fungi(21.87%).The main gram-negative bacteria were Acinetobacter bauerii,Klebsiella pneumoniae,Escherichia coli and Pseudomonas aeruginosa.Staphylococcus aureus was the most common gram-positive bacteria.In the special flora,the detection rate of ESBL E.coli obviously showed an upward trend,while the detection rates of CRPA and MRSA showed a downward trend;the detection rate of carbapenem-resistant Acinetobacter bauerii(CRAB)was not statistically significant.Drug resistance analysis showed that Acinetobacter baumannii was most highly drug-resistant to different kinds of antibiotics.The resistance rates of K.pneumoniae to imipenem and ertapenem were relatively lower.The drug resistance rates of E.coli to the third and fourth generation cephalosporins were lower than 30%.The resistance rates of P.aeruginosa to penicillins and cephalosporins were generally high,and the resistance rates to ciprofloxacin and gentamicin were less than 10%.CONCLUSION The bacterial composition ratio of nosocomial infection was mainly gram-negative Acinetobacter baumannii,and the detection rate of ESBL E.coli was high,with the severe drug resistance situation.The prevention and control of drug-resistan

关 键 词：细菌感染 抗菌药物 耐药性 病原菌 医院感染监测 医院感染实时监控系统 

分 类 号：R183[医药卫生—流行病学]