2013-2021年河南省某三甲医院血流感染病原菌分布及耐药性变迁  

Distribution and drug resistance change of pathogenic bacteria in bloodstream infection in an A-level tertiary hospital in Zhengzhou from 2013 to 2021

作　　者：孙静静[1] 徐璐 刘彩林[1] 徐岷[1] 孙玉蕊 叶亚菲[1] SUN Jingjing;XU Lu;LIU Cailin;XU Min;SUN Yurui;YE Yafei(Clinical Laboratory,the First Afiliated Hospital of Zhengzhou University,Key Clinical Laboratory,Henan Province,Zhengzhou,Henan 450052,China;Clinical Laboratory,Henan Children's Hospital Zhengzhou Children's Hospital;Clinical Laboratory,XinxiangInfectious DiseaseHospital)

机构地区：[1]郑州大学第一附属医院检验科河南省检验医学重点实验室,河南郑州450052 [2]河南省儿童医院郑州儿童医院检验科 [3]新乡市传染病医院检验科

出　　处：《现代疾病预防控制》2023年第5期338-344,349,共8页MODERN DISEASE CONTROL AND PREVENTION

基　　金：国家自然科学基金(82102438)。

摘　　要：目的分析血培养病原菌的分布及耐药性变迁,为临床血流感染的诊治提供依据。方法回顾性分析河南省某三甲医院2013-2021年门诊及住院患者的血培养标本中分离的细菌,将菌株分为2013-2015年、2016-2018年、2019-2021年3个时间段,采用WHONET 5.6软件进行细菌构成及药敏结果的统计分析,SPSS 19.0软件对耐药率差异进行统计学分析。结果共检出非重复细菌20432株,其中革兰阴性菌占57.0%,革兰阳性菌占43.0%。分离菌顺位排序前5位分别是:大肠埃希氏菌(4517株,22.1%)、凝固酶阴性葡萄球菌(4341株,21.2%)、肺炎克雷伯菌(2992株,14.6%)、金黄色葡萄球菌(1194株,5.8%)和屎肠球菌(1067株,5.2%)。9年间大肠埃希氏菌对亚胺培南的耐药率由1.9%上升至4.4%;肺炎克雷伯菌对亚胺培南的耐药率由18.3%上升至47.8%;鲍曼不动杆菌对头孢他啶、头孢曲松、头孢吡肟、亚胺培南、头孢哌酮/舒巴坦、氨苄西林/舒巴坦、哌拉西林/他唑巴坦、庆大霉素、环丙沙星的耐药率均维持在80.0%以上;铜绿假单胞菌对哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、庆大霉素、妥布霉素、左氧氟沙星和阿米卡星的耐药率均在15.0%以下;耐甲氧西林金黄色葡萄球菌的检出率为41.8%(499/1194)。结论血培养病原菌以革兰阴性菌为主,主要分离菌对临床常用药物细菌耐药性呈上升趋势,肺炎克雷伯菌对碳青霉烯类抗菌药物耐药率较高,应加强细菌耐药性监测,合理使用抗菌药物。Objective To analyze the distribution and drug resistance change of pathogenic bacteria in bloodstream infection,so as to provide evidence for the diagnosis and treatment of clinical bloodstream infection.Methods The bacteria isolated from blood culture samples in an A-level tertiary hospital in Zhengzhou from 2013 to 2021 were retrospectively analyzed.According to the time duration,the strains were divided into three groups:2013-2015,2016-2018 and 2019-2021.The bacterial composition and drug sensitivity results were statistically analyzed by WHONET 5.6 software;statistical analysis for the difference of drug resistance rates was conducted by SPSS 19.0 software.Results A total of 20432 non-repetitive bacteria were detected in blood culture in the past 9 years,of which Gram-negative bacteria accounted for 57.0%,and Gram-positive bacteria accounted for 43.0%.The top five isolates were Escherichia coli(4517 strains,22.1%),coagulase-negative Staphylococcus(4341 strains,21.2%),Klebsiella pneumoniae(2992 strains,14.6%),Staphylococcus aureus(1194 strains,5.8%)and Enterococcus faecium(1067 strains,5.2%).During the nine years,the resistance rate of Escherichia coli to imipenem increased from 1.9%to 44%;the resistance rate of Klebsiella pneumoniae to imipenem increased from 18.3%to 47.8%.The resistance rates of Acinetobacter baumanni to ceftazidime,ceftriaxone,cefepime,imipenem,cefoperazone/sulbactam,ampicillin/sulbactam,piperacillin/tazobactam,gentamicin and ciprofloxacin allremained above 80.0%;the resistance rates of Pseudomonas aeruginosa to piperacillin/tazobactam,ceftazidime,cefepime,gentamycin,tobramycin,levofloxacin and amikacin all were below 15.0%.The detection rate of methicillin-resistant Staphylococcus aureus in blood culture was 41.8%(499/1194).Conclusions The pathogenic bacteria identified from blood culture are mainly Gram-negative,and the drug resistance of the main isolated bacteria to commonly used clinical drugs is on the rise;the resistance rate of Klebsiella pneumoniae to carbapenem antimicrobial drug

关 键 词：血培养 病原菌分布 耐药性 

分 类 号：R446.5[医药卫生—诊断学]