社区、医疗保健相关性及医院感染细菌的耐药性差异  

Differences in antimicrobial resistance of bacteria among community-acquired,healthcare-associated and hospital-acquired infections

作　　者：李亚美 梁乐[1] 王鹏鹏 Li Yamei;Liang Le;Wang Pengpeng(Department of Pharmacy,Xi'an No.1 Hospital,the First Affiliated Hospital of Northwest University,Xi'an 710002,China)

机构地区：[1]西安市第一医院,西北大学附属第一医院药剂科,西安710002

出　　处：《中华临床感染病杂志》2024年第3期205-212,共8页Chinese Journal of Clinical Infectious Diseases

基　　金：陕西省科技计划项目(2024SF-YBXM-340)。

摘　　要：目的了解社区、医疗保健相关性及院内感染细菌的分布和耐药性差异。方法收集2019年1月至2023年12月西安市第一医院不同临床标本的分离细菌, 根据感染场所分为社区获得性感染(community-acquired infection, CAI)组、医疗保健相关性感染(healthcare-associated infection, HCAI)组和医院获得性感染(hospital-acquired infection, HAI)组, 比较三组细菌的分布和耐药性差异。采用SPSS 22.0统计软件对数据进行分析。结果共收集细菌9 762株, CAI组2 258株(23.1%), HCAI组763株(7.8%), HAI组6 741株(69.1%)。HCAI组大肠埃希菌检出率低于CAI组, 高于HAI组(χ^(2)=106.335和69.603, P值均<0.001);铜绿假单胞菌和鲍曼不动杆菌检出率均高于CAI组(χ^(2)=35.749和65.098, P值均<0.001), 低于HAI组(χ^(2)=26.350和115.885, P值均<0.001);金黄色葡萄球菌检出率高于CAI和HAI组(χ^(2)=5.745和13.992, P值均<0.05)。HCAI组耐甲氧西林金黄色葡萄球菌(methicillin-resistantStaphylococcus aureus, MRSA)检出率低于HAI组(χ^(2)=69.005, P<0.001), MRSA对左氧氟沙星和莫西沙星的耐药率均高于CAI组(χ^(2)=13.634和13.083, P值均<0.001), 低于HAI组(χ^(2)=17.927和21.937, P值均<0.001)。HCAI组大肠埃希菌对哌拉西林/他唑巴坦、头孢曲松、头孢他啶、头孢哌酮/舒巴坦、环丙沙星及左氧氟沙星的耐药率均高于CAI组, 对头孢哌酮/舒巴坦、美罗培南、亚胺培南及阿米卡星的耐药率均低于HAI组(P值均<0.05)。除呋喃妥因外, HCAI组肺炎克雷伯菌对其他抗菌药物的耐药率均高于CAI组, 而低于HAI组(P值均<0.01)。HCAI组铜绿假单胞菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、美罗培南和亚胺培南的耐药率均高于CAI组(χ^(2)=14.107、14.819、16.822和15.998, P值均<0.001), 低于HAI组(χ^(2)=7.821、4.671、18.070和17.552, P值均<0.05)。HCAI组鲍曼不动杆菌对哌拉西林/他唑巴坦、美罗培南、亚胺培南、环丙沙星和左氧氟沙星的耐药率均�ObjectiveTo investigate the bacterial isolate distribution and differences of antimicrobial resistance among community-acquired infection,healthcare-associated infection and hospital-acquired infection.MethodsBacterial isolates from clinical specimens were collected in Xi'an No.1 Hospital between January 2019 and December 2023 and categorized into community-acquired infection(CAI),healthcare-associated infection(HCAI)and hospital-acquired infection(HAI).The bacterial distribution and antimicrobial resistance differences among the three groups were compared.Data were analyzed with SPSS 22.0 statistical software.ResultsA total of 9762 bacterial strains were collected:2258 strains(23.1%)in CAI group,763 strains(7.8%)in HCAI group and 6741 strains(69.1%)in HAI group.In HCAI group,the detection rate of Escherichia coli was lower than that in CAI group,and higher than that in HAI group(χ^(2)=106.335 and 69.603,both P<0.001).The detection rates of Pseudomonas aeruginosa and Acinetobacter baumannii in HCAI group were higher than those in CAI group(χ^(2)=35.749 and 65.098,both P<0.001),and lower than those in HAI group(χ^(2)=26.350 and 115.885,both P<0.001).The detection rate of Staphylococcus aureus in HCAI group was higher than that in CAI and HAI groups(χ^(2)=5.745 and 13.992,both P<0.05).In HCAI group,the detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was lower than that in HAI group(χ^(2)=69.005,P<0.001);and MRSA in HCAI demonstrated higher resistance to levofloxacin and moxifloxacin than that in CAI group(χ^(2)=13.634 and 13.083,both P<0.001),and lower than that in HAI group(χ^(2)=17.927 and 21.937,both P<0.001).The resistance rates of Escherichia coli to piperacillin/tazobactam,ceftriaxone,ceftazidime,cefoperazone/sulbactam,ciprofloxacin and levofloxacin in HCAI group were higher than those in CAI group,and the resistance rates to cefoperazone/sulbactam,meropenem,imipenem and amikacin in HCAI group were lower than those in HAI group(all P<0.05).For Klebsiella pneumoniae,the resistance rat

关 键 词：耐药性 社区获得性感染 医疗保健相关性感染 院内获得性感染 

分 类 号：R446.5[医药卫生—诊断学]