2018—2022年中国医学科学院肿瘤医院深圳医院细菌耐药性监测  

Drug resistance surveillance in Cancer Hospital&Shenzhen Hospital Chinese Academy of Medical Sciences,2018-2022

作　　者：吴卫星 张丽 张晓煜 党秀敏 谢争华 何希川 肖敏 吴宗勇[2] 齐军 WU Weixing;ZHANG Li;ZHANG Xiaoyu;DANG Xiumin;XIE Zhenghua;HE Xichuan;XIAO Min;WU Zongyong;QI Jun(National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen,Guangdong 518116,China;不详)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院检验科,广东深圳518116 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院

出　　处：《中国国境卫生检疫杂志》2024年第5期517-524,共8页Chinese Journal of Frontier Health and Quarantine

基　　金：中国医学科学院肿瘤医院深圳医院院内科研课题(E010321008);深圳市医疗卫生三名工程基金项目(SZSM202311002)。

摘　　要：目的分析2018—2022年深圳肿瘤医院临床分离病原菌的分布及其对抗菌药物耐药性的变迁。方法依据美国临床实验室标准化协会(CLSI)指南选取35种抗生素,采用纸片扩散法和E-test重点测定肿瘤患者感染中常见病原菌对抗生素的敏感性,药敏结果参考CLSI 2022版指南解读,用WHONET 5.6软件进行统计分析。结果2018—2022年,共分离到5582株临床非重复病原菌,其中革兰阳性菌1945株(34.8%),革兰阴性菌3637株(65.2%)。耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)及耐甲氧西林金黄色葡萄球菌(MRSA)的比率分别为70.1%~84.1%和9.6%~23.9%,屎肠球菌对多数抗菌药物的敏感性低于粪肠球菌,葡萄球菌属和肠球菌属均未表现出对利奈唑胺、万古霉素、替考拉宁和替加环素耐药;在肺炎克雷伯菌和大肠埃希菌中,产超广谱β内酰胺酶(ESBLs)阳性率分别是18.3%~28.3%和50.6%~58.1%,ESBLs对抗菌药物的耐药率均比非ESBLs株高,耐碳青霉烯肠杆菌目(CRE)阳性率为1.1%,铜绿假单胞菌对美罗培南和亚胺培南的耐药率分别是2.6%~12.6%和3.4%~15.6%;鲍曼不动杆菌对美罗培南和亚胺培南的耐药率均低于12.7%。结论深圳医院肿瘤患者感染的病原菌以革兰阴性杆菌为主,产ESBLs大肠埃希菌检出率处于高位,碳青霉烯类耐药革兰阴性杆菌仍需警惕,应继续加强肿瘤患者耐药菌的监测。Objective To investigate the distribution and susceptibility profile of clinical isolates in Shenzhen Cancer Hospital from 2018 to 2022.Methods According to the guidelines of Clinical and Laboratory Standards Institute(CLSI),the sensitivity to 35 antibiotics of common pathogens isolated from tumor patients were tested by disk diffusion method and E-test.The interpretation of antimicrobial susceptibility was based on the CLSI 2022 guidelines,and statistical analysis was performed through WHONET 5.6 software.Results A total of 5582 clinical strains were isolated from 2018 to 2022,of which Gram negative bacilli and Gram positive cocci accounted for 34.8%(1945)and 65.2%(3637)respectively.The overall prevalence of methicillin resistant strains was 70.1%-84.1%in coagulase negative Staphylococcus(MRCNS)and 9.6%-23.9%in S.aureus(MRSA).The sensitivity of Enterococcus faecium to most antimicrobial drugs was lower than that of Enterococcus faecalis.Neither Staphylococcus nor Enterococcus genera exhibited resistance to linezolid,vancomycin,teicoplanin or tigecycline.The prevalence of strains of extended-spectrumβ-lactamase(ESBLs)producing strains was 18.3%-28.3%in K.pneumoniae and 50.6%-58.1%in E.coli.ESBLs producing Enterobacteriaeeae strains were more resistant than non-ESBLs producing strains in terms of antibiotic resistance rate.The positive rate of carbapenem resistant Enterobacteriaceae(CRE)was 1.1%.The resistance rates of Pseudomonas aeruginosa to meropenem and imipenem were 2.6%-12.6%and 3.4%-15.6%,respectively.The resistance rates of Acinetobacter baumannii to both meropenem and imipenem were below 12.7%.Conclusion Gram negative bacilli were the main pathogens in cancer patients in Shenzhen Cancer Hospital.ESBLs producing E.coli had still high detection rate.Carbapenem resistant Gram negative bacilli still need to be vigilant.It is necessary to strengthen surveillance of drug-resistant bacteria in cancer patients.

关 键 词：肿瘤患者 细菌耐药 耐甲氧西林金黄色葡萄球菌 碳青霉烯类耐药肠杆菌目细菌 产超广谱Β内酰胺酶 

分 类 号：R446.5[医药卫生—诊断学]