广东省2019—2023年耐万古霉素屎肠球菌检出率升高的时空变迀研究

Spatiotemporal variation of the increased detection rate of vancomycin-resistant Enterococcus faecium in Guangdong Province,2019-2023

目的分析近年广东省耐万古霉素屎肠球菌(VR-Efm)临床分离株的时空分布,探寻VR-Efm检出率上升的原因。方法回顾性分析2019—2023年广东省4个区域(珠三角、粤东、粤西、粤北)的38所医疗机构上报至广东省细菌耐药监测系统中VR-Efm检出情况、患者人口学特征及科室和标本分布等资料,同步分析世界卫生组织重点关注的ESKAPE中其他5种细菌的检出情况。结果广东省VR-Efm检出率从2019年1.4%(63/4543)上升至2023年21.3%(1351/6345),呈明显上升趋势,2023年44.7%(17所)的医疗机构VR-Efm检出率>20%;广东省4个区域VR-Efm检出率普遍上升,以珠三角地区为中心向周围辐射增长。ESKAPE整体由2019年10.1%升至2023年10.8%,其余5种病原体中,耐碳青霉烯类肺炎克雷伯菌检出率从2019年8.0%上升至2023年15.0%,耐碳青霉烯类鲍曼不动杆菌、耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类铜绿假单胞菌和耐碳青霉烯类肠杆菌属检出率分别从2019年的61.6%、34.4%、21.2%、7.9%下降至2023年的58.2%、31.9%、21.0%、7.6%,皆有不同程度下降。ICU VR-Efm检出率(12.2%)高于门急诊(9.4%)、内科(9.2%)和外科(7.0%)等非ICU科室(均P<0.05)。VR-Efm检出率较高标本分别为尿(9.8%)、血(9.1%),其余标本检出率介于6.9%~9.6%。青少年患者VR-Efm检出率(4.4%)低于中老年患者(>9.4%,P<0.05)。结论近5年广东省VR-Efm检出率明显上升,可能与社区和医院获得的优势克隆传播有关。有条件的医疗机构应对入院患者开展VR-Efm的筛查,并对检出VR-Efm的患者采取有效防控措施,以遏制VR-Efm检出率在该区域的上升。

Objective To analyze the spatiotemporal distribution of clinically isolated vancomycin-resistant Enterococcus faecium(VR-Efm)in Guangdong Province in recent years,and explore the causes for the increase in VR-Efm detection rate.Methods A retrospective analysis was conducted on the data about the detection,patients’demographic characteristics,as well as departments and specimens distribution of VR-Efm reported to Guangdong Province Antimicrobial Resistance Surveillance System by 38 medical institutions in 4 regions of Guangdong Province(Pearl River Delta,East Guangdong,West Guangdong,and North Guangdong)in 2019-2023.The detection of 5 other antimicrobial-resistant ESKAPE(Enterococcus faecium,Staphylococcus aureus,Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,Enterobacter species)concerned by World Health Organization was analyzed synchronously.Results The detection rate of VR-Efm in Guangdong Province increased from 1.4%(63/4543)in 2019 to 21.3%(1351/6345)in 2023,showing a significant upward trend.In 2023,44.7%(n=17)medical institutions had a VR-Efm detection rate of>20%;the detection rate of VR-Efm in 4 regions of Guangdong Province has generally increased,with a radiation increase from the Pearl River Delta region to the surrounding areas.The overall ESKAPE increased from 10.1%in 2019 to 10.8%in 2023.Among the other 5 pathogens,the de-tection rate of carbapenem-resistant Klebsiella pneumoniae increased from 8.0%in 2019 to 15.0%in 2023.The detection rates of carbapenem-resistant Acinetobacter baumannii,methicillin-resistant Staphylococcus aureus,carbapenem-resistant Pseudomonas aeruginosa,and carbapenem-resistant Enterobacter spp.decreased from 61.6%,34.4%,21.2%,and 7.9%in 2019 to 58.2%,31.9%,21.0%,and 7.6%in 2023,respectively,all showed varying degrees of decline.The detection rate of VR-Efm in intensive care unit(ICU)(12.2%)was higher than that in non-ICU departments such as outpatient and emergency department(9.4%),internal medicine department(9.2%)and surgery department(7.0%)(all P<0.05).The specimens with higher detection rates of VR-Efm were urine(9.8%)and blood(9.1%),while the detection rates of other specimens ranged from 6.9%to 9.6%.The detection rate of VR-Efm from adolescent patients was lower than that of middle-aged and elderly patients(4.4%vs>9.4%,P<0.05).Conclusion In the past 5 years,the detection rate of VR-Efm in Guangdong Province has significantly increased,which may be related to the transmission of dominant clone acquired from communities and hospitals.Medical institutions with favorable condition should conduct VR-Efm screening for hospitalized patients,take effective prevention and control measures for patients with VR-Efm,so as to curb the increase in detection rate of VR-Efm in the region.