2017-2022年山东地区不同人群腹水病原菌构成及药敏分析  

Pathogen spectrum and drug susceptibility analysis of intra-abdominal infections in different populations in Shandong Province,2017-2022

作　　者：李静[1,2] 李政 王梦园[1,2] 纪冰 满思金 伊茂礼[5] 李仁哲[6] 王世富[1,2] Li Jing;Li Zheng;Wang Mengyuan;Ji Bing;Man Sijin;Yi Maoli;Li Renzhe;Wang Shifu(Department of Microbiology Laboratory,Children's Hospital Affiliated to Shandong University,Shandong Provincial Clinical Research Center for Children's Health and Disease,Jinan 250022;Shandong Children Microbiology Research Center,Shandong Children's Bacterial&Fungal Drug Resistance Surveillance and Research Collaborative Network,Jinan 250022;Clinical Laboratory,Binzhou Medical University Hospital,Binzhou 256603;Clinical Laboratory,Central People's Hospital of Tengzhou,Tengzhou 277500;Clinical Laboratory,Yantai Yuhuangding Hospital,Yantai 264000;Clinical Laboratory,Jining First People's Hospital,Jining 272111)

机构地区：[1]山东大学附属儿童医院临床微生物科,山东省儿童健康与疾病临床医学研究中心,济南250022 [2]山东省儿童微生物组学研究中心儿童细菌&真菌耐药监测研究协作网,济南250022 [3]滨州医学院附属医院检验科,滨州256603 [4]滕州市中心人民医院检验科,滕州277500 [5]烟台毓璜顶医院检验科,烟台264000 [6]济宁市第一人民医院检验科,济宁272111

出　　处：《中国抗生素杂志》2024年第12期1411-1418,共8页Chinese Journal of Antibiotics

摘　　要：目的回顾性分析山东地区不同年龄段腹水病原菌构成和耐药性差异,为临床腹腔感染的早期经验性治疗提供参考依据。方法利用WHONET5.6分析软件,回顾分析山东地区2017—2022年间山东省儿童组细菌&真菌耐药监测研究协作网成员单位上报的腹水病原菌构成及主要病原菌药敏结果。结果本次研究共纳入病原菌10991株,革兰阴性菌占比为57.1%(6281/10991),以肠杆菌目细菌为主(83.73%),其次为非发酵菌(14.87%);革兰阳性菌占比38.23%(4202/10991),以葡萄球菌属为主(14.94%),其次为肠球菌属(14.73%);真菌共检出470株,其中白念珠菌占比最高(53.4%),其次为热带念珠菌(15.7%)。成人检出前5位的菌种为大肠埃希菌(28.92%)、肺炎克雷伯菌(9.21%)、屎肠球菌(8.47%)、表皮葡萄球菌(5.46%)、粪肠球菌(4.35%);儿童组检出前5位的菌种为大肠埃希菌(51.18%)、铜绿假单胞菌(7.58%)、肺炎克雷伯菌(6.96%)、屎肠球菌(5.22%)、表皮葡萄球菌(2.48%),两组间革兰阳性菌、革兰阴性菌和真菌的构成有较大差异(χ2=102.1,P<0.0001)。山东省腹水分离的大肠埃希菌和肺炎克雷伯菌中产ESBLs株的占比分别为(27.5%)和(16.4%),两种菌对碳青霉烯类药物耐药率均较低,分别为1.4%和3.8%。铜绿假单胞菌和鲍曼不动杆菌耐药率普遍较高,两者对碳青霉烯类药物的耐药率分别为9.5%和56.3%。未发现耐万古霉素屎肠球菌、粪肠球菌和金黄色葡萄球菌。耐甲氧西林金黄色葡萄球菌的检出率为20.4%,热带念珠菌对氟康唑的耐药率为37.3%。结论山东地区儿童组与成人组腹水病原菌构成有一定差异,多重耐药的大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌检出率较高,耐氟康唑的热带念珠菌占比较高,需重点监测。实时监测腹水的病原谱和耐药趋势特点,将助力腹腔感染的精准诊治。Objective To analyze the pathogen spectrum and drug resistance in different age groups of acites in Shandong Province,and provide a reference for early empirical therapy of intra-abdominal infection.Methods WHONET5.6 analysis software was used to retrospectively analyze the pathogenic bacteria composition and drug susceptibility of the main pathogens reported by SPARSS network members in Shandong Province from 2017 to 2022.Results A total of 10,991 strains of pathogenic bacteria were enrolled in this study,mainly Gram-negative bacteria(57.1%),of which Enterobacteriaceae was dominant(83.73%),followed by non-fermentative bacteria(14.87%).Gram-positive bacteria accounted for 38.23%(4,202/10,991).The main Gram-positive bacteria were Staphylococcus spp.(14.94%),followed by Enterococcus spp.(14.73%).A total of 470 strains of fungi were detected.Candida albicans accounted for the highest proportion(53.4%),followed by Candida tropicalis(15.7%).The top 5 bacterial strains detected in adults were Escherichia coli(28.92%),Klebsiella pneumoniae(9.21%),Enterococcus faecalis(8.47%),Staphylococcus epidermidis(5.46%),and Enterococcus faecalis(4.35%).The top 5 bacterial strains detected in the children's group were Escherichia coli(51.18%),Pseudomonas aeruginosa(7.58%),Klebsiella pneumoniae(6.96%),Enterococcus faecalis(5.22%),and Staphylococcus epidermidis(2.48%).There were significant differences in the distribution of Gram-positive bacteria,Gram-negative bacteria and fungi between the children's group and the adults'group(χ2=102.1,P<0.0001).The proportion of ESBLs produced by Escherichia coli and Klebsiella pneumoniae isolated from ascites in Shangdong Province was 27.5%and 16.4%,respectively.The resistance rates of both bacteria to carbapenems were relative lower,at 1.4%and 3.8%,respectively.The drug resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii were generally high,with resistance rates to carbapenems of 9.5%and 56.3%,respectively.No vancomycin-resistant Enterococcus faecium,Enterococcus faecalis,or v

关 键 词：腹腔感染 细菌 耐药性 监测 SPARSS 

分 类 号：R978[医药卫生—药品]