2012—2021年江西某三甲医院临床分离肺炎链球菌的分布及耐药率变化  

Changing distribution and antimicrobial resistance profiles of Streptococcus pneumoniae isolated from a tertiary hospital in Jiangxi Province from 2012 to 2021

作　　者：邓林强[1] 陈益国[1] 陈会[1] 杜宇娜 DENG Linqiang;CHEN Yiguo;CHEN Hui;DU Yuna(Department of Laboratory Medicine,Jiangxi Provincial People's Hospital,the First Affiliated Hospital of Nanchang Medical College,Nanchang 330006,China)

机构地区：[1]江西省人民医院检验科(南昌医学院第一附属医院),南昌330006

出　　处：《中国感染与化疗杂志》2023年第4期480-485,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解江西某三甲医院肺炎链球菌分布及抗菌药物耐药率变化,为临床的预防与治疗提供参考依据。方法采用回顾性分析,对2012—2021年分离出肺炎链球菌的患者分布及该菌对12种抗菌药物耐药率变化特点进行分析。结果①10年共分离出985株肺炎链球菌,主要分离自呼吸道标本(91.3%),10年间标本分布比较差异存在统计学意义(P<0.001)。不同病区间,内科病区患者总分离率占比较高(38.2%),儿科分布较少(0.6%);病区分布上差异存在统计学意义(P<0.01)。时间上,第三季度肺炎链球菌总分离率较低(15.4%),10年间比较差异有统计学意义(P<0.001)。②944株成人患者临床非脑脊液标本分离出的肺炎链球菌中,对青霉素敏感、中介和耐药的菌株数分别为854株(90.5%)、59株(6.2%)和31株(3.3%)。854株对青霉素敏感的肺炎链球菌10年间对阿莫西林-克拉维酸耐药率从2012年的15.7%下降到2021年的0,对头孢曲松耐药率从2012年的11.8%下降到2021年的5.3%,对红霉素的耐药率从2012年的76.5%上升到2021年的92.9%。未发现对利奈唑胺和万古霉素耐药的菌株。结论该院10年间分离出肺炎链球菌的患者在病区、标本种类和时间分布上存在差异。肺炎链球菌对β内酰胺类及其酶抑制剂复方制剂等抗菌药物耐药率有所下降,在治疗青霉素敏感肺炎链球菌感染时,仍可作为重要选择。Objective To investigate the distribution and antimicrobial resistance profiles of Streptococcus pneumoniae in a tertiary hospital in Jiangxi Province for improving clinical prevention and treatment.Methods A retrospective analysis was conducted to analyze the distribution of S.pneumoniae strains isolated from 2012 to 2021 and the changing antimicrobial susceptibility profiles to 12 antimicrobial agents.Results A total of 985 strains of S.pneumoniae were isolated in the 10-year period,mainly from respiratory specimens(91.3%).The distribution of specimens varied significantly over the 10-year period(P<0.001).The over prevalence of S.pneumoniae was significantly higher(38.2%)in the wards of internal medicine compared to pediatric ward(0.6%)(P<0.01).The overall prevalence of S.pneumoniae was significantly lower in autumn(15.4%)in the 10-year period compared to the other three quarters(P<0.001).Among the 944 strains of nonmeningitis S.pneumoniae isolated from adults,the prevalence of penicillin-susceptible(PSSP),penicillin-intermediate(PISP),and penicillin-resistant(PRSP)strains was 90.5%(854/944),6.2%(59/944),and 3.3%(31/944),respectively.In the 854 PSSP strains isolated from adults,the resistance rate to amoxicillin-clavulanic acid decreased from 15.7%in 2012 to 0 in 2021,and the resistance rate to ceftriaxone decreased from 11.8%in 2012 to 5.3%in 2021.The resistance rate to erythromycin increased from 76.5%in 2012 to 92.9%in 2021.No strains were resistant to linezolid or vancomycin.Conclusions The quarter,specimen and ward distributions of S.pneumoniae isolates varied significantly during the 10-year period in a tertiary hospital.The S.pneumoniae isolates showed decreasing resistance rates toβ-lactams andβ-lactam/β-lactamase inhibitor combinations over the 10-year period.These antibiotics are still important treatment options for PSSP infections.

关 键 词：肺炎链球菌 耐药率 最低抑菌浓度 青霉素 

分 类 号：R378.14[医药卫生—病原生物学]