2017-2022年某三甲医院血流感染病原菌临床特征及耐药趋势分析  

Analysis of clinical characteristics and drug resistance trend of pathogenic bacteria in bloodstream infections from 2017 to 2022

作　　者：杨永新 朱金芬[1] 马澜 张尚弟[1] 孟灵[1] Yang Yongxin;Zhu Jinfen;Ma Lan;Zhang Shangdi;Meng Ling(Laboratory Medicine Center,The Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院检验医学中心,甘肃兰州730030

出　　处：《兰州大学学报（医学版）》2023年第6期45-54,共10页Journal of Lanzhou University（Medical Sciences）

基　　金：国家自然科学基金资助项目(32060231);甘肃省自然科学基金资助项目(21JR1RA130)。

摘　　要：目的研究分析2017-2022年血培养分离细菌的临床分布情况及对主要抗菌药物的耐药性,为临床抗感染方案的选择和院内感染的防控提供指导。方法收集2017年1月-2022年12月兰州大学第二医院阳性血培养分离菌株,采用全自动微生物质谱检测系统VITEK MS、全自动细菌鉴定及药敏分析系统VITEK2 Compact以及纸片扩散法进行菌株鉴定和抗菌药物敏感性实验,WHONET 5.6软件对菌株的临床科室分布及耐药情况进行统计分析。结果检出非重复病原菌5094株,其中革兰氏阴性菌2632株(51.67%),主要有大肠埃希菌(20.95%)、表皮葡萄球菌(12.94%)、肺炎克雷伯菌(9.23%)、金黄色葡萄球菌(7.68%)等,分布科室主要有重症医学科(19.34%)、普外科(19.18%)、儿科(17.03%)等。大肠埃希菌对头孢哌酮/舒巴坦的耐药率下降至0.60%,鲍曼不动杆菌对多种抗菌药物的耐药性呈持续上升趋势,对美罗培南的耐药率由2017年的62.50%上升至2022年的81.00%,铜绿假单胞菌对头孢他啶近6年的平均耐药率为25.30%,金黄色葡萄球菌对青霉素的耐药率在90.00%以上,屎肠球菌对万古霉素100.00%敏感。碳青霉烯耐药肺炎克雷伯菌的检出率2018年达到29.10%,2022年下降至14.70%,但依旧高于甘肃省以及全国的平均检出率。耐甲氧西林金黄色葡萄球菌检出率由2017年的65.10%下降至2022年的26.40%,超广谱β-内酰胺酶阳性菌株检出率2017年为44.20%,2022年为15.50%。结论血培养分离菌株种类地区差别不明显,但在科室分布、对抗菌药物耐药性及其变化趋势均存在不同程度的地区差异性,规范血培养检测,做好本地区细菌耐药监测对血流感染疾病诊疗、院内感染防控及遏制微生物耐药有着非常重要的意义。Objective To analyze the distribution and antimicrobial resistance in the bacterial strains isolated from blood cultures from 2017 to 2022,aiming to provide guidance for the selection of clinical anti-infection programs and the control of nosocomial infections.Methods Strains were isolated from positive blood culture samples collected from The Second Hospital of Lanzhou University from January 2017 to December 2022.Automatic microbial mass spectrometry system VITEK MS and automatic bacterial identification and drug sensitivity analysis system VITEK2 compact and disk diffusion method were used for strain identification and an antibiotic sensitivity test.WHONET 5.6 software performed statistical analysis on the clinical distribution and drug resistance of the isolated bacteria.Results 5094 strains of non-repeating pathogens were detected in the blood culture samples,of which 2632 strains of Gram-negative bacteria(51.67%)were detected,mainly including Escherichia coli(20.95%),Staphylococcus epidermoides(12.94%),Klebsiella pneumoniae(9.23%),Staphylococcus aureus(7.68%),etc.The distribution departments mainly included the intensive care unit(19.34%),general surgery(19.18%),pediatrics(17.03%),etc.The resistance rate of Escherichia coli to cefoperazone/sulbactam decreased to 0.60%,the resistance rate of Acinetobacter baumannii to multiple antibacterial agents showed a continuous rising trend,the resistance rate of meropenem increased from 62.50%in 2017 to 81.00%in 2022,and the average resistance rate of Pseudomonas aeruginosa to ceftazidme in the past six years was 25.30%.The resistance rate of Staphylococcus aureus to penicillin was more than 90.00%,and Enterococcus faecium was 100.00%sensitive to vancomycin.The detection rate of Carbapenem resistant Klebsidium pneumonias reached 29.10%in 2018 and decreased to 14.70%in 2022,but it was still higher than the average detection rate in Gansu Province and the whole country.The detection rate of Methicillin resistant Staphylococcus aureus decreased from 65.10%in 2017 to 26.4

关 键 词：血流感染 多重耐药菌 抗菌药物 碳青霉烯类耐药 细菌耐药检测 

分 类 号：R378[医药卫生—病原生物学]