2016—2021年山东省11个地区摩根摩根菌的抗生素耐药变迁

Changes of antibiotic resistance rates of M organella morganii in11 regions of Shandong Province from 2016 to 2021

目的 分析山东省2016—2021年摩根摩根菌的抗生素耐药变迁趋势,了解摩根摩根菌耐药特征,为临床合理用药提供数据支持。方法 回顾性分析2016—2021年山东省11个地区14家医院838株摩根摩根菌临床分离株的耐药数据。根据分离标本的组织来源不同,将摩根摩根菌分为泌尿系统(UT)组(n=271)、呼吸系统(RT)组(n=161)、皮肤软组织(SST)组(n=294)和其他组(n=112)。采用线性回归方法分析耐药率随时间的变化。采用Pearson χ^(2)检验或Fisher精确检验分析组间差异。结果 2016—2021年山东省摩根摩根菌对氨苄西林/舒巴坦的耐药率呈线性下降趋势(P=0.005),对头孢哌酮/舒巴坦的耐药率呈线性上升趋势(P=0.006)。2017—2020年山东省摩根摩根菌对左氧氟沙星的耐药率均高于全国水平(P<0.05)。UT组摩根摩根菌对阿米卡星、庆大霉素、妥布霉素、氨曲南、氨苄西林/舒巴坦、哌拉西林/他唑巴坦、复方新诺明、环丙沙星、左氧氟沙星的耐药率高于RT组(P均<0.05);对庆大霉素、头孢吡肟、氨曲南、哌拉西林/他唑巴坦、环丙沙星、左氧氟沙星的耐药率高于SST组(P均<0.05)。结论 山东省摩根摩根菌对多种抗生素的耐药性普遍较高,其中对喹诺酮类抗生素的耐药性最高,各级医疗机构应加强对喹诺酮类药物的合理应用。推荐使用头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢吡肟和阿米卡星作为治疗摩根摩根菌感染的一线药物。

Objective To investigate the changing trend of antibiotic resistance of Morganella morganii in Shandong Province from 2016 to 2021, and to explore the drug resistance characteristics, in order to provide data support for rational clinical use. Methods The drug resistance data of 838 clinical isolates of Morganella morganii from 14 hospitals in 11 regions of Shandong Province from 2016 to 2021 were retrospectively analyzed. According to the tissue sources, the isolated specimens were divided into urinary tract(UT) group(n=271), respiratory tract(RT) group(n=161), skin soft tissue(SST) group(n=294) and other groups(n=112). Linear regression was used to analyze the trend of drug resistance, and Pearson χ^(2) or Fisher’s exact test were used to analyze the differences among groups. Results From 2016 to 2021, the resistance rate of Morganella morganii to ampicillin/sulbactam showed a linear downward trend(P=0.005), while the resistance rate to cefoperazone/sulbactam showed a linear upward trend(P=0.006). The drug resistance rate of Morganella morganii to levofloxacin in Shandong Province from 2017 to 2020 was higher than that of the national level(P<0.05). The drug resistance rates of Morganella morganii in the UT group to amikacin, gentamicin, tobramycin, aztreonam, ampicillin/sulbactam, piperacillin/tazobactam, compound sulfamethoxazole, ciprofloxacin and levofloxacin were higher than those in RT group(all P<0.05). The resistance rates of Morganella morganii to gentamicin, cefepime, aztreonam, piperacillin/tazobactam, ciprofloxacin and levofloxacin in the UT group were higher than those in the SST group(all P<0.05). Conclusion In Shandong Province, the drug resistance of Morganella morganii to a variety of antibiotics is generally high, and the drug resistance to quinolones is the highest. Medical institutions at all levels should strengthen the rational application of quinolones. The use of cefoperazone/sulbactam, piperacillin/tazobactam, cefepime, and amikacin as first-line agents for the treatment of Morganella morganii infection is recommended.