SARS-CoV-2合并感染患者的病原微生物分布特征及耐药性分析  

Distribution characteristics and drug resistance analysis of pathogenic microorganisms in patients co-infected with SARS-CoV-2 and other infection

作　　者：吉金山[1] 赵娜[2] 王莉[2] 谷秀娟[2] 赵菊梅[1] JI Jinshan;ZHAO Na;WANG Li;GU Xiujuan;ZHAO Jumei(Medical College of Yan'an University,Yan'an 716000,China;Dongguan Branch Laboratory,Affiliated Hospital of Yan'an University,Yan'an 716000,China)

机构地区：[1]延安大学医学院,陕西延安716000 [2]延安大学附属医院东关分院检验科,陕西延安716000

出　　处：《延安大学学报（医学科学版）》2024年第1期24-28,共5页Journal of Yan'an University:Medical Science Edition

基　　金：延安市科技计划项目(SL2020ZCSY-003)。

摘　　要：目的分析严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)合并感染患者病原微生物分布特点及耐药情况,为临床诊治提供依据。方法收集2022年12月至2023年2月延安大学附属医院收治的2019冠状病毒病(corona virus disease 2019,COVID-19)患者637例的临床资料,回顾性分析其临床特征及合并感染病原微生物情况。结果COVID-19患者以老年人为主,合并基础疾病患者占79.59%,好转及痊愈患者高达91.05%。培养阳性标本来源于呼吸道、血液和尿液,合并感染的病原微生物分别以肺炎克雷伯杆菌、凝固酶阴性葡萄球菌(coagulase negative staphylococci,CNS)和真菌为主。药敏试验结果显示,肺炎克雷伯杆菌对β内酰胺类抗生素及三代、四代头孢菌素类抗生素耐药率较低(14%~20%),鲍曼不动杆菌对氨基糖苷类抗生素和β内酰胺类复合物较为耐药(均>45%),大肠埃希菌对β内酰胺类抗生素及其复合物耐药率较低(14%~19%)。金黄色葡萄球菌、CNS、屎肠球菌、粪肠球菌均未发现对万古霉素、利奈唑胺、替加环素耐药。结论COVID-19合并感染病原体以革兰阴性菌及真菌为主,感染部位以呼吸道为主,主要病原菌为肺炎克雷伯杆菌。鲍曼不动杆菌对氨基糖苷类抗生素和β内酰胺类复合物耐药率高于全国细菌耐药平均水平,提示临床上应根据COVID-19患者的微生物鉴定和药敏试验结果,选择对症药物治疗,以改善患者预后。Objective To analyze the distribution characteristics and drug resistance of pathogenic microorganisms in patients co-infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and other infection,so as to provide evidence for clinical treatment.Methods The clinical data of 637 patients with corona virus disease 2019(COVID-19)infection admitted to the Affiliated Hospital of Yan´an University from December 2022 to February 2023 were collected,and their clinical characteristics and co-infection of pathogenic microorganisms were analyzed retrospectively.Results The patients were mainly elderly,with 79.59%of patients complicated with underlying diseases,and 91.05%of patients improved and recovered.The most common types of culture positive specimens were respiratory tract,blood and urine,with infections mainly caused by Klebsiella pneumoniae,coagulase negative staphylococci(CNS)and fungi,respectively.The drug sensitivity test results showed that Klebsiella pneumoniae had a low resistance rate toβ-lactam and the third and fourth generations of cephalosporins(14%~20%).Acinetobacter baumannii was more resistant to aminoglycosides andβ-lactam compounds(both>45%),and the resistance rate of Escherichia coli toβ-lactam and its compounds was low(14%~19%).Staphylococcus aureus,CNS,Enterococcus faecium and Enterococcus faecalis were not found to be resistant to vancomycin,linezolid and tigacycline.Conclusion The pathogens of COVID 19 co-infection were mainly Gramnegative bacteria and fungi,and the infection site was mainly respiratory tract,and the main pathogen was Klebsiella pneumoniae.The resistance rate of Acinetobacter baumannii to aminoglycosides andβ-lactam compounds was higher than the national average level of bacterial drug resistance.It is suggested that in clinical practice,appropriate therapeutic drugs should be selected based on the microbial identification and drug sensitivity test results of COVID-19 patients,in order to improve their prognosis.

关 键 词：SARS-CoV-2 COVID-19 细菌感染 真菌感染 耐药性 

分 类 号：R446.1[医药卫生—诊断学]