2019—2021年甘肃省老年患者临床分离菌分布及耐药性分析  

Distribution of clinical isolates and drug resistance in elderly patients in Gansu Province from 2019 to 2021

作　　者：崔亚丽 焦凤媛 王雯婕 景玉洁 李可可 魏莲花[2] Cui Ya-li;Jiao Feng-yuan;Wang Wen-jie;Jing Yu-jie;Li Ke-ke;Wei Lian-hua(Gansu University of Traditional Chinese Medicine,Lanzhou 730000;Gansu Provincial Hospital Clinical Laboratory Department,Lanzhou 730000)

机构地区：[1]甘肃中医药大学,兰州730000 [2]甘肃省人民医院检验科,兰州730000

出　　处：《中国抗生素杂志》2023年第9期1064-1074,共11页Chinese Journal of Antibiotics

基　　金：国家自然科学基金资助项目(No.81960385);甘肃省人民医院科技创新平台基金项目(No.22GSSYD-58);甘肃省医学检验临床医学研究中心(No.21JR7RA676)。

摘　　要：目的分析2019—2021年甘肃省老年患者临床分离菌的分布特点及其耐药性。方法收集甘肃省2019年1月—2021年12月各个医院≥65岁的老年患者临床分离菌,用药敏纸片扩散法、最低抑菌浓度(MIC)法和E试验法测定细菌对抗菌药物敏感性,根据CLSI标准判读结果,采用WHONET 5.6软件分析结果。结果甘肃省2019—2021年≥65岁的老年患者临床分离菌均以革兰阴性菌为主,占比分别为79.4%、80.4%和79%,均以大肠埃希菌的检出率最高,革兰阳性菌中以金黄色葡萄球菌的检出率最高,近3年均在35%左右,其中耐甲氧西林金葡菌(MRSA)的检出率分别为35.2%、37.5%和36%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为67.9%、66.8%和71.1%,且MRSA和MRCNS对抗菌药物的耐药率均高于甲氧西林敏感金黄色葡萄球菌(MSSA)和甲氧西林敏感凝固酶阴性葡萄球菌(MSCNS),未发现对万古霉素、替考拉宁耐药的菌株。粪肠球菌近3年检出率呈上升趋势,屎肠球菌的检出率维持在2.5%左右;第三代头孢菌素类耐药的大肠埃希菌的检出率高于肺炎克雷伯菌;铜绿假单胞菌对妥布霉素、多黏菌素B的耐药率有下降趋势,分别从11.5%下降到7.6%,从2.3%下降到1.3%,而对头孢哌酮/舒巴坦的耐药率有上升趋势,鲍曼不动杆菌多各类抗菌药物的耐药率均高于铜绿假单胞菌。结论甘肃省老年患者临床分离病原体以革兰阴性菌为主,耐药现状严重,对老年患者临床病原菌进行耐药性分析,有助于临床为老年患者合理运用抗菌药物,以减少抗菌药物的滥用。Objective To analyze the distribution characteristics and drug resistance of clinical isolates from elderly patients in Gansu Province from 2019 to 2021.Methods Clinical isolates of bacteria isolated from elderly patients in various hospitals in Gansu Province from January 2019 to December 2021 were collected.The antimicrobial susceptibility of bacteria was determined by the disk diffusion method,the minimum inhibitory concentration(MIC)method,the E test method.According to the CLSI standard,the results were analyzed by WHONET5.6 software.Results The clinical isolates of elderly patients aged≥65 in Gansu Province from 2019 to 2021 were mainly Gram-negative bacteria,accounting for 79.4%,80.4%,79%,respectively.The detection rate of Escherichia coli was the highest.Staphylococcus aureus was the highest among Gram-positive bacteria,which was about 35%in recent three years.The detection rates of methicillin-resistant Staphylococcus aureus(MRSA)were 35.2%,37.5%,36%,respectively.The detection rates of methicillin-resistant coagulase-negative Saphylococci(MRCNS)were 67.9%,66.8%,71.1%,respectively,the antimicrobial resistance rates of MRSA and MRCNS were higher than those of methicillin-sensitive Staphylococcus aureus(MSSA)and methicillin-sensitive coagulasenegative Staphylococci(MSCNS).No strains resistant to vancomycin and teicoplanin were found.The detection rate of Enterococcus faecalis showed an upward trend in the past three years,the detection rate of Enterococcus faecium was about 2.5%.The detection rate of Escherichia coli resistant to third generation cephalosporins was higher than that of Klebsiella pneumoniae.The resistance rate of Pseudomonas aeruginosa to tobramycin and polymyxin B decreased from 11.5%to 7.6%,from 2.3%to 1.3%,while the resistance rate to cefoperazone/sulbactam increased.The resistance rates of Acinetobacter baumannii to many kinds of antibiotics were higher than those of Pseudomonas aeruginosa.Conclusion Gram-negative bacteria are the main pathogens isolated from elderly patients in Gansu

关 键 词：老年患者 耐药监测 抗菌药物 耐药率 多重耐药菌 合理用药 

分 类 号：R978[医药卫生—药品]