某医院2015—2020年尿路感染病原菌分布及耐药性变迁  

Distribution of pathogenic bacteria of urinary tract infection and changes of drug resistance in a hospital from 2015 to 2020

作　　者：王颍源[1] 方盼盼[2] 赵艳梅[1] 李朝晖[1] WANG Ying-yuan;FANG Pan-pan;ZHAO Yan-mei;LI Zhao-hui(Department of Neonatal Intensive Care Unit,Children’s Hospital Affiliated to Zhengzhou University,Zhengzhou 450018,China;Zhengzhou Key Laboratory of Children’s Infection and Immunity,Children’s Hospital Affiliated to Zhengzhou University,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院新生儿重症监护室,郑州450018 [2]郑州大学附属儿童医院郑州市儿童感染与免疫重点实验室,郑州450018

出　　处：《医药论坛杂志》2023年第23期1-8,共8页Journal of Medical Forum

基　　金：河南省科技厅科技攻关项目(222102310171);河南省医学科技攻关计划联合共建项目(LHGJ20210636)。

摘　　要：目的了解郑州大学附属儿童医院2015年1月至2020年12月尿路感染病原菌的分布及耐药性变迁,监测耐药性变化,为临床合理用药提供依据。方法采用WHONET 5.6软件,分析6年间(2015年1月至2020年12月)郑州大学附属儿童医院尿路感染患儿分离获得的主要病原细菌分布及抗菌药物耐药变迁情况。结果剔除同一患者重复菌株后,1236例尿路感染患儿共检出1309株致病菌,其中革兰阴性菌687株(52.48%),革兰阳性菌562株(42.93%),真菌60株(4.58%)。主要革兰阴性菌是大肠埃希菌(352株,26.89%)和肺炎克雷伯菌(102株,7.79%);屎肠球菌(270株,20.63%)、粪肠球菌(215株,16.42%)是最多见的革兰阳性菌。6年间,大肠埃希菌检出比例明显降低,由31%下降至20.06%(χ^(2)=12.374,P=0.03);其它主要检出菌肺炎克雷伯菌、屎肠球菌、粪肠球菌检出比例维持稳定(均P>0.05),阴道加德纳菌近两年检出率明显升高(χ^(2)=18.107,P<0.001)。本研究中产超广谱β-内酰胺酶(extended Spectrum Beta-Lactamases,ESBLs)大肠埃希菌检出率在2015年至2020年间发生显著的下降(P<0.05),大肠埃希菌对头孢曲松、左旋氧氟沙星、呋喃妥因的耐药率均发生有统计学意义的变化(均P<0.05),其中头孢曲松2018年耐药率高达79.59%,而至2019年和2020年有下降趋势。对头孢吡肟和复方磺胺甲恶唑(复方新诺明)持续维持较高的耐药率(均P>0.05),2020年复方磺胺甲恶唑耐药率更高达82.26%;大肠埃希菌对阿米卡星、亚胺培南、呋喃妥因、头孢哌酮/舒巴坦耐药率较低,2020年对上述药物的耐药率分别为6.45%、11.29%、3.23%、14.25;且2015年至2020年间,肺炎克雷伯菌对常用抗菌药物的耐药率各时间段间差异无统计学意义(均P>0.05),肺炎克雷伯菌各年碳青霉烯耐药的肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)检出率普遍高于大肠埃希菌;2015年至2020年间粪肠球菌对高浓度庆大霉素耐药率均发生有统计Objective To understand the distribution of urinary tract infection pathogens and the changes in drug resistance from January 2015 to December 2020 in the Children's Hospital of Zhengzhou University,monitor the changes in drug resistance,and provide a basis for clinical rational use of drugs.Methods The WHONET 5.6 software was used to analyze the distribution of the main pathogenic bacteria and the changes in antimicrobial resistance of children with urinary tract infections admited from January 2015 to December 2020.Results After excluding duplicate strains from the same patient,a total of 1,309 pathogenic bacteria were detected in 1,236 children with urinary tract infections,including 687(52.48%)Gram-negative bacteria,562 Gram-positive bacteria(42.93%),and 60 fungus(4.58%).The main gram-negative bacteria were Escherichia coli(352 strains,26.89%)and Klebsiella pneumoniae(102 strains,7.79%);Enterococcus faecium(270 strains,20.63%),Enterococcus faecalis(215 strains,16.42%)was the most common gram-positive bacteria.In 6 years,the detection rate of Escherichia coli decreased significantly,from 31%to 20.06%(χ^(2)=12.374,P=0.03);The rates of detection of other major detected bacteria(Klebsiella pneumoniae,Enterococcus faecium,and Enterococcus faecalis)remained stable(P>0.05),and the detection rate of Gardnerella vaginalis increased significantly in the past two years(χ^(2)=18.107,P<0.001).The detection rate of ESBLs-producing Escherichia coli in this study decreased significantly from 2015 to 2020(P<0.05),and the changes of resistance rates of Escherichia coli to ceftriaxone,levofloxacin,and nitro-furantoin were all statistically in academic significance(P<0.05),the resistance rate of ceftriaxone in 2018 was as high as 79.59%,and there was a downward trend in 2019 and 2020;To cefepime and compound sulfamethoxazole con-tinued to maintain a high resistance rate(P>0.001),the resistance rate of compound sulfamethoxazole in 2020 was as high as 82.26%;E.coli is relatively sensitive to amikacin,imipenem,nitrofurantoin,and

关 键 词：儿童 尿路感染 药物敏感性试验 病原菌 细菌耐药 尿液培养 

分 类 号：R726.9[医药卫生—儿科]