2015-2022年某中医院奇异变形杆菌检出率及耐药率变化趋势

Trend of isolation rate and antimicrobial resistance rate of Proteus mirabilis in a hospital of Traditional Chinese Medicine from 2015 to 2022

目的 通过长期监测和数据对比,探索奇异变形杆菌某些缓慢而持续的变化趋势,为临床感染性疾病的诊疗及院感防控提供方向及依据。方法 使用WHONET 5.6软件及SPSSAU数据科学分析平台(Cochran-armitage检验),回顾性分析江苏省中医院2015年1月1日-2022年12月31日期间,临床标本中分离的奇异变形杆菌的检出率、耐药率、标本分布及科室分布的变化趋势。结果 去除同一住院患者重复分离的相同菌株后,共1 569株奇异变形杆菌纳入分析;2015-2022年奇异变形杆菌的总检出率为3.32%,在革兰阴性菌、肠杆菌科细菌、变形杆菌属细菌中的检出率分别为4.90%、8.80%和85.46%,连续8年检出率均呈上升趋势(P<0.05);奇异变形杆菌主要分布于痰标本、尿标本及分泌物标本中,且在痰标本中的占比呈上升趋势(P<0.05),在尿标本中的占比呈下降趋势(P<0.05);奇异变形杆菌检出前三的科室为ICU、老年科和泌尿外科,在ICU及老年科的占比呈上升趋势(P<0.05);奇异变形杆菌对环丙沙星、磺胺甲噁唑/甲氧苄啶、头孢曲松、左氧氟沙星、氨苄西林/舒巴坦的耐药率呈上升趋势(P<0.001),对哌拉西林/他唑巴坦的耐药率呈下降趋势(P<0.05)。结论 奇异变形杆菌在该医院内存在流行趋势,可能成为医院感染,特别是呼吸道感染的更常见病原菌。在ICU及老年科等综合性科室流行的风险更高,应加强对相关科室的目标性监测,督促临床合理使用抗菌药物。

OBJECTIVE To explore the slow and continuous change trend of Proteus mirabilis through long-term monitoring and data comparison, and to provide direction and basis for clinical diagnosis and treatment of infectious diseases and prevention and control of nosocomial infections. METHODS A retrospective analysis of P.mirabilis isolated from clinical specimens from Jan 2015 to Dec 2022 was performed. WHONET5.6 software and SPSSAU data science analysis platform(Cochran-armitage test) were used to analyze the changing trends of the isolation rate, antimicrobial resistance rate, specimen distribution and department distribution of P.mirabilis for eight consecutive years. RESULTS A total of 1 569 strains of P.mirabilis were included in the analysis after repeated strains from the same patient were removed. The overall isolation rate of P.mirabilis in all clinical pathogens from 2015 to 2022 was 3.32%, and the isolation rates in gram-negative bacteria, Enterobacteriaceae bacteria and Proteus genus were 4.90%, 8.80% and 85.46%, respectively, showing an increasing trend for eight consecutive years(P<0.05). P.mirabilis was mainly distributed in sputum, urine and secretions, and its detection rates in sputum specimens showed an increasing trend(P<0.05), while that in urine specimens showed a decreasing trend(P<0.05). The top 3 departments for the isolation of P.mirabilis were ICU, geriatric department and urology department. The distributions of P.mirabilis in ICU and geriatric department showed an increasing trend(P<0.05). The drug-resistance rates of P.mirabilis to ciprofloxacin, trimethoprim-sulfamethoxazole, ceftriaxone, levofloxacin and ampicillin-sulbactam showed an increasing trend(P<0.001), while that to piperacillin-tazobactam showed a decreasing trend(P<0.05). CONCLUSION P.mirabilis is prevalent in this hospital, which may cause nosocomial infections, especially respiratory infections. The epidemic risk of P.mirabilis is highly in ICU and geriatric departments. It is necessary to strengthen the targeted monitoring of relevant departments, and urge the rational use of antibiotics in clinical practice.