2017年至2024年间不同阶段湖南某三甲妇产医院病原菌构成变迁及耐药分析  

Evolution of Pathogenic Bacteria Composition and Antibiotic Resistance Analysis in a Tertiary Obstetrics and Gynecology Hospital in Hunan from 2017 to 2024 at different stages

作　　者：刘栋宾 张衎 刘俊[1] 刘亚倩 陈敏[1] 谭继权 LIU Dongbin;ZHANG Kan;LIU Jun;LIU Yaqian;CHEN Min;TAN Jiquan(Department of Laboratory Medicine,Hunan Maternal and Child Health Hospital,Changsha Hunan 410008,China)

机构地区：[1]湖南省妇幼保健院检验科,湖南长沙410008

出　　处：《临床研究》2025年第4期190-198,共9页Clinical Research

基　　金：湖南省自然科学基金项目(2025JJ80650);湖南省妇幼保健院院内课题基金(2021RX17)。

摘　　要：目的对比分析2017至2024年间某不同阶段妇产科医院分离得到的病原菌及其药敏数据。方法根据新型冠状病毒感染防控大致阶段收集2017年1月至2019年12月、2020年1月至2022年12月及2023年1月至2024年6月于湖南省妇幼保健院就诊患者中分离得到的病原菌及药敏结果,根据不同时间将其分为A组、B组、C组,并进行统计学分析。结果3组共送检样本204911例,总体阳性率为15.58%。送检样本前3位分别为生殖道、全血及呼吸道。C组生殖道样本、呼吸道样本阳性率均高于A组及B组,全血样本阳性率低于A组及B组。C组生殖道送检样本白色念珠菌及光滑念珠菌检出率高于B组及A组,差异均有统计学差异(P<0.05)。C组呼吸道送检样本流感嗜血杆菌检出率高于B组及A组,差异均有统计学差异(P<0.05)。C组全血样本黏质沙雷菌检出率高于B组及A组,差异均有统计学差异(P<0.05)。生殖道样本中无乳链球菌、大肠埃希菌,呼吸道样本中肺炎克雷伯菌、嗜麦芽窄食单胞菌检出率均呈现出连年上升趋势、全血样本中大肠埃希菌检出率呈现连年下降趋势。无乳链球菌对红霉素、四环素、克林霉素耐药率较高。粪肠球菌对利福平、四环素、庆大霉素耐药率较高。金黄色葡萄球菌对大多数药物耐药率较A组有所下降。C组大肠埃希菌耐药增幅较明显的为:氨苄西林/舒巴坦,余下多数药物耐药率较A组有所下降;肺炎克雷伯菌耐药增幅较明显的为:哌拉西林/他唑巴坦、左氧氟沙星;产气肠杆菌耐药增幅较明显的为哌拉西林/他唑巴坦。结论新型冠状病毒感染防控不同阶段,妇女及儿童送检病原菌检出及构成有所差异。注重药物使用频数及用量,规范控制病原菌的传播,可有效降低细菌的耐药率。Objective To compare and analyze the pathogenic bacteria isolated at different stages in an obstetrics and gynecology hospital from 2017 to 2024,along with their antibiotic susceptibility data.Methods Pathogenic bacteria and their sensitivity results were collected from patients visiting Hunan Maternal and Child Health Hospital during three periods:January 2017 to December 2019,January 2020 to December 2022,and January 2023 to June 2024.These periods were categorized based on the major stages of COVID-19 infection control and divided into groups A,B,and C for statistical analysis.Results A total of 204,911 specimens were submitted,with an overall positivity rate of 15.58%.The top three specimen sources were the reproductive tract,whole blood,and respiratory tract.The positivity rates for reproductive and respiratory tract samples in group C were higher than those in groups A and B,while the positivity rate for whole blood samples was lower.Group C samples showed higher detection rates of Candida albicans and Candida glabrata in reproductive samples,Haemophilus influenzae in respiratory samples,and Serratia marcescens in blood samples compared to groups A and B,with statistically significant differences(P<0.05).Streptococcus agalactiae and Escherichia coli were undetected in reproductive samples,whereas Klebsiella pneumoniae and Stenotrophomonas maltophilia detection rates in respiratory samples showed an annual increase.The detection rate of Escherichia coli in blood samples showed an annual decline.Streptococcus agalactiae showed high resistance to erythromycin,tetracycline,and clindamycin,while Enterococcus faecium showed high resistance to rifampicin,tetracycline,and gentamicin.The resistance rate of Staphylococcus aureus to most drugs decreased compared to group A.Notable increases in Escherichia coli resistance in group C were seen with ampicillin/sulbactam,while most other drug resistances declined compared to group A.Significant increases in resistance were observed for Klebsiella pneumoniae to piperacilli

关 键 词：妇产科 抗菌药物 监测 耐药性 感染与预防控制 

分 类 号：R473.71[医药卫生—护理学]