新疆2016-2018年血流感染革兰阴性菌分布及耐药性变迁研究

Distribution and drug resistance of Gram-negative bacteria in bloodstream infection in Xinjiang from 2016 to 2018

目的了解新疆地区2016-2018年血流感染革兰阴性菌的分布及耐药性变迁。方法收集新疆自治区细菌耐药监测网36家医院2016-2018年血液标本15707份,共分离出革兰阴性菌7982株。对菌株进行药敏试验,并进行统计分析。结果7982株革兰阴性菌中,位于前5位的依次是大肠埃希菌(50.3%)、肺炎克雷伯菌(21.9%)、鲍曼不动杆菌(6.4%)、阴沟肠杆菌(4.3%)和铜绿假单胞菌(3.3%)。大肠埃希菌、肺炎克雷伯菌对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦有很高的敏感性,但对氨苄西林、头孢呋辛、头孢曲松、头孢噻肟、复方新诺明的耐药率均在50.0%以上。2016-2018年碳青霉烯类耐药大肠埃希菌的检出率分别为2.3%、1.6%、1.1%,耐碳青霉烯酶肺炎克雷伯菌的检出率分别为6.9%、8.5%、11.4%。鲍曼不动杆菌除对头孢哌酮/舒巴坦、阿米卡星、复方新诺明的耐药率低于42.0%外,对其他临床常用抗菌药物的耐药率均在50.0%以上。铜绿假单胞菌对临床常用抗菌药物的敏感性总体较高。结论新疆地区血流感染革兰阴性菌对常用抗菌药物耐药性的问题很严峻,应高度重视该地区细菌耐药监测结果,加强感染控制管理,合理使用抗菌药物。

Objective To understand the distribution and drug resistance of Gram-negative bacteria in bloodstream infection in Xinjiang from 2016 to 2018.Methods 15707 blood samples were collected from 36 hospitals of Xinjiang bacterial resistance surveillance network from 2016 to 2018.A total of 7982 Gram-negative bacteria were isolated.Drug susceptibility test and statistical analysis of the strains were carried out.Results 7982 Gram-negative bacteria,the top five were Escherichia coli(50.3%),Klebsiella pneumoniae(21.9%),Acinetobacter baumannii(6.4%),Enterobacter cloacae(4.3%)and Pseudomonas aeruginosa(3.3%).Escherichia coli and Klebsiella pneumoniae were highly susceptible to cefoperazone/sulbactam and piperacillin/tazobactam,but their resistance rates to ampicillin,cefuroxime,ceftriaxone,cefotaxime and SMZco were all above 50.0%.From 2016 to 2018,the detection rates of carbapenem-resistant Escherichia coli were 2.3%,1.6%and 1.1%respectively,and the detection rates of carbapenem-resistant Klebsiella pneumoniae were 6.9%,8.5%and 11.4%respectively.The resistance rate of Acinetobacter baumannii to cefoperazone/sulbactam,amikacin and compound trimethoprim was less than 42.0%,and the resistance rate to other commonly used antibiotics was more than 50.0%.Pseudomonas aeruginosa was generally more susceptible to commonly used antibiotics.Conclusion The problem of resistance of Gram-negative bacteria to commonly used antibiotics in bloodstream infection in Xinjiang is very serious.We should attach great importance to the results of surveillance of bacterial resistance,strengthen infection control and management,and rationally use antibiotics.