2017—2021年四川省精神卫生中心血流感染的病原菌分布与耐药性变迁

Changing distribution and antimicrobial resistance of pathogens isolated from bloodstream infections in Sichuan Mental Health Center from 2017 to 2021

目的 分析四川省精神卫生中心住院患者血流感染的病原菌分布以及耐药性变迁情况,为以老年医学和精神医学为特色的综合医院中诊治血流感染疾病提供参考依据。方法 采用回顾性方法,收集2017年1月—2021年12月四川省精神卫生中心血流感染患者的临床资料和实验室检查数据,进行分析。结果 纳入精神卫生中心收治的血流感染患者2 011例,年龄范围在0~99岁,中位数66岁,男女比例为1∶1.14,其中细菌血流感染98.3%、真菌血流感染1.7%。血培养分离出非重复病原菌2 169株,其中革兰阴性菌血流感染1 401例(64.6%),以大肠埃希菌(808例,37.3%)和肺炎克雷伯菌(285例,13.1%)为主;革兰阳性菌血流感染733例(33.8%),以金黄色葡萄球菌(124例,5.7%)为主。2017—2021年,精神卫生中心精神科收治住院患者20 879例,其中发生血流感染135例,占0.6%,老年精神病患者(>60岁)占74.8%;老年医学科收治住院患者14 160例,其中发生血流感染185例,占1.3%。血流感染中,对碳青霉烯类抗生素耐药的大肠埃希菌和肺炎克雷伯菌分离率分别为1.0%和3.9%;对碳青霉烯类抗生素耐药的铜绿假单胞菌和鲍曼不动杆菌分离率分别为13.0%和69.4%。血流感染中甲氧西林耐药金黄色葡萄球菌的分离率为31.5%。未发现耐万古霉素肠球菌(VRE)菌株。精神疾病患者血流感染中分离的大肠埃希菌对喹诺酮类药物的耐药率低于全院总体水平,老年患者血流感染分离的肺炎克雷伯菌对第三代头孢菌素耐药率高于全院总体水平。结论 以精神医学和老年医学为特色的综合医院血流感染患者以老年居多,病原菌以革兰阴性杆菌为主,应对重症医学科、老年医学科及精神科病区的病原菌分布及其耐药性加强监测以合理选择抗菌药物。

Objective To review the changing distribution and antimicrobial resistance profile of pathogens isolated from bloodstream infections(BSIs)in the inpatients in Sichuan Mental Health Center for improving clinical diagnosis and treatment of BSIs in the general hospitals featuring psychiatric diseases and geriatric medicine.Methods A retrospective study was conducted to review and analyze the clinical and laboratory data of the patients with BSI in Sichuan Mental Health Center from January 2017 to December 2021.Results A total of 2011 patients with BSI were included in this analysis.The median(range)age of patients was 66(0-99)years old.Male to female ratio was 1:1.14.The BSIs included bacteremia(98.3%)and fungemia(1.7%).Overall,2169 nonduplicate strains of pathogens were isolated from blood culture,including 1401(64.6%)gram-negative bacteria and 733(33.8%)gram-positive bacteria.The main gram-negative bacteria were Escherichia coli(37.3%,808/2169)and Klebsiella pneumoniae(13.1%,285/2169).The main gram-positive bacteria was Staphylococcus aureus(5.7%,124/2169).From 2017 to 2021,20879 patients were admitted to psychiatric departments of the Mental Health Center.Overall,135(0.6%)patients developed BSI,and 74.8%of the patients were elderly(>60 years).Among the 14 160 inpatients in geriatrics department, 185 (1.3%) patients developed BSI. The carbapenem-resistant Escherichia coli andKlebsiella pneumoniae accounted for 1.0% and 3.9% in the pathogens of BSIs, respectively. The prevalence of carbapenem-resistantstrains was 13.0% in Pseudomonas aeruginosa and 69.4% in Acinetobacter baumannii. The prevalence of MRSA in BSIs was 31.5%.No vancomycin-resistant Enterococcus strain was isolated. The E. coli strains isolated from BSIs in patients with mental illness showedlower level of quinolones resistance than the overall level in the hospital. The K. pneumoniae strains isolated from BSIs in the elderlyshowed higher level of resistance to the third-generation cephalosporins than the overall level in the hospital. Conclusions In generalhospitals featuring psychiatry and geriatrics, BSI was more frequently identified in the elderly. Gram-negative bacilli are the mainpathogens. Therefore, it is necessary to strengthen surveillance of pathogen distribution and antimicrobial resistance in ICU, geriatricsand psychiatric wards for rational antimicrobial therapy.