2017-2021年辽宁省人民医院常见病原菌分布及细菌耐药性变迁

Clinical distribution and drug resistance changes of common pathogenic bacteria in Liaoning Provincial People′s Hospital from 2017 to 2021

目的分析辽宁省人民医院2017-2021年临床分离出来的常见病原菌的分布和耐药情况,以指导临床医生合理用药。方法回顾性分析2017-01-01-2021-12-31辽宁省人民医院上传中国细菌耐药监测网(CHINET)的数据。采用Vitek-2全自动微生物分析仪和K-B纸片扩散法进行鉴定及药敏试验,依照美国临床实验室标准化协会(CLSI)2020年版标准对药敏结果进行判读,应用WHONET 5.6软件对其进行数据分析。结果2017-2021年从临床共检出9233株非重复菌株;其中革兰阳性菌2220株(24.04%),以金黄色葡萄球菌718株(32.34%)为被检出的最主要的细菌;革兰阴性菌7013株(75.96%),以肺炎克雷伯菌1501株(21.40%)检出率最高。病原菌标本分布主要以痰液、尿液和血液为主。而耐碳青霉烯肠杆菌科细菌(CRE)的检出率在逐年上升,从2017年12.6%上升至2021年20.8%,其中肺炎克雷伯菌占比最高,对亚胺培南和美罗培南耐药率分别为41.7%和41.5%,主要分离科室为ICU。鲍曼不动杆菌对碳氢霉烯普遍耐药,而铜绿假单胞菌对碳氢霉烯的耐药率可达43.2%和36.8%。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率在20.3%~49.2%,目前未发现对万古霉素、替考拉宁和替加环素耐药的葡萄球菌,但已出现耐万古霉素肠球菌(VRE)。屎肠球菌对大多数抗菌药物的耐药率明显高于粪肠球菌,两者对万古霉素、利奈唑胺、替考拉宁以及替加环素具有较好的敏感性。结论5年来我院耐药形势逐渐严峻,分别以肺炎克雷伯菌和金黄色葡萄球菌检出率最高,应合理规范化使用抗菌药物,加强院感防控及耐药监测。

Objective The distribution and drug resistance of common pathogens isolated from 2017 to 2021 in Liaoning Provincial people’s Hospital were analyzed in order to guide clinicians to use drugs rationally.Methods Retrospective analysis of data uploaded to the China Bacterial Resistance Surveillance Network(CHINET)at Liaoning Provincial People′s Hospital from January 1,2017 to December 31,2021.The Vitek-2 fully automated microbiological analyzer and the K-B paper diffusion method were used for identification and drug sensitivity testing,and the results were interpreted according to the American Clinical Laboratory Standardization Institute(CLSI)2020 standard and analyzed using WHONET 5.6 software.Results From 2017 to 2021,a total of 9233 non-repeat strains were detected from the clinic in our hospital;among them,2220 strains(24.04%)were Gram-positive bacteria,with Staphylococcus aureus 718 strains(32.34%)being the most predominant bacteria detected;7013 strains(75.96%)were Gram-negative bacteria,with Klebsiella pneumoniae 1501 strains(21.40%)having the highest detection rate.The distribution of pathogenic bacteria specimens was mainly based on sputum,urine and blood.The detection rate of carbapenem-resistant Enterobacteriaceae(CRE)is increasing year by year,from 12.6%in 2017 to 20.8%in 2021,with Klebsiella pneumoniae accounting for the highest rate,with 41.7%and 41.5%resistance to imipenem and meropenem,respectively,and the main isolation unit is ICU.Acinetobacter baumannii was generally resistant to hydrocarbons,while Pseudomonas aeruginosa was resistant to hydrocarbons at rates of up to 43.2%and 36.8%.The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)ranged from 20.3%to 49.2%.Vancomycin-,ticoranine-,and tigecycline-resistant staphylococci have not been identified,but vancomycin-resistant enterococci(VRE)have emerged.Enterococcus faecalis was significantly more resistant to most antimicrobial drugs than Enterococcus faecalis,and both had better susceptibility to vancomycin,linezolid,teicoplanin,and tigecycline.Conclusions In the past five years,the situation of drug resistance in our hospital is becoming more and more serious,and the detection rates of Klebsiella pneumoniae and Staphylococcus aureus are the highest.Rational and standardized use of antibiotics should be strengthened to strengthen hospital prevention and control and drug resistance monitoring.