2012—2019年某医院血流感染病原菌变迁及耐药性分析

The epidemiology of bacteria separated from blood cultures and antimicrobial resistance patterns in a hospital from 2012 to 2019

目的分析医院8年间血流感染病原菌分布及耐药性变迁,为血流感染的经验性治疗提供参考。方法回顾性分析某院2012年1月—2019年12月分离自住院患者血培养阳性的标本,对病原菌的构成及药敏数据进行汇总,利用SPSS软件对数据进行统计分析。结果8年共检出病原菌2374株,其中革兰阳性菌627株(26.4%);革兰阴性菌1747株(73.6%)。前5位分离菌为大肠埃希菌735株(31.0%),肺炎克雷伯菌429株(18.1%),金黄色葡萄球菌144株(6.1%),鲍曼不动杆菌126株(5.3%)和凝固酶阴性葡萄球菌104株(4.4%)。与2012—2013年相比,2018—2019年大肠埃希菌检出率明显下降,肺炎克雷伯菌和凝固酶阴性葡萄球菌的检出率明显增加(P<0.05);大肠埃希菌对常用抗菌药物的敏感率相对稳定。肺炎克雷伯菌对哌拉西林/三唑巴坦、头孢曲松、头孢吡肟、环丙沙星、亚胺培南和美罗培南等的敏感率,分别从2012—2013年的93.0%、73.7%、91.2%、80.7%、100.0%、100.0%,显著下降至2018—2019年的69.1%、54.3%、65.1%、53.1%、74.3%和74.9%。鲍曼不动杆菌耐药日趋严重,至2018—2019年除对阿米卡星(57.6%)外,大多数抗菌药物敏感率低于25%,亚胺培南耐药率为75.8%。与金黄色葡萄球菌相比,凝固酶阴性葡萄球菌对常用抗菌药物的耐药性更高,甲氧西林不敏感率为88.4%,明显高于金黄色葡萄球菌的21.6%,对万古霉素、替考拉宁和替加环素保持100%的敏感性。结论血流感染以革兰阴性菌为主,但革兰阳性菌有增长趋势,主要分离菌对临床常用抗菌药物耐药性逐年增加,应密切关注血流感染常见菌群的分布及耐药性变迁。

Objective To describe the epidemiology of pathogens isolated from blood cultures and antimicrobial resistance over the eight-year period.Methods This study retrospectively analyzed data from blood cultures and sensitivity testing in our hospital from January 2012 to December 2019.SPSS software was used to compare the pathogens changes and antimicrobial resistance.Results A total of 2374 strains were isolated with the Gram-negative bacteria account for 73.6%(1,747 strains),and Gram-positive bacteria account for 26.4%(627 strains).The most frequently isolates were Escherichia coli(735 strains,31.0%),Klebsiella pneumonia(429 strains,18.1%),Staphylococcus aureus(144 strains,6.1%),Acinetobacter baumanii(126 strains,5.3%),and coagulase-negative Staphylococcus(104 strains,4.4%).Compared with the year of 2012 to 2013,a significantly increased isolation was observed in Klebsiella pneumoniae and coagulase-negative Staphylococcus,but a significantly decreased isolation was observed in Escherichia coli from the year 2018 to 2019(P<0.05).The increasing trends of resistance rates of E.coli to most of tested antibiotics were not found over the 8-year period.However the antimicrobial susceptibility of Klebsiella pneumonia isolated from the year 2018 to 2019 was obviously lower than that from the year 2012-2013,such as Piperacillin tazobactam(69.1%vs.93.0%),ceftriaxone(54.3%vs.73.7%),cefepime(65.1%vs.91.2%),ciprofloxacin(53.1%vs.80.7%),imipenem(74.3%vs.100.0%),and meropenem(74.9%vs.100.0%).The resistance of Acinetobacter Baumanii against most of antibiotics showed increasing trends with the sensitivity rate to most antibiotics lower than 25%in the years from 2018 to 2019 expect amikacin(57.6%).The resistance rate of Acinetobacter baumanii against imipenem reached over 75.8%.Compared with Staphylococcus aureus,coagulasenegative Staphylococcus showed higher resistance to common antibiotics.The prevalence of methicillin-resistant coagulase-negative Staphylococcus and methicillin-resistant Staphylococcus aureus was 88.4%and 21.6%respectively in the years from 2018 to 2019.But they showed completed sensitivity to vancomycin,linezolid and tegacycline.Conclusions The Gram-negative bacteria were most frequently isolated from bloodstream cultures and showed an increasing tendency during the past 8 years.Antibiotic resistance rates have been rising for most predominant organisms,and therefore calls for concerted efforts aimed at resistant organisms and dynamic surveillance.