2015—2019年腹腔积液标本病原菌分布及抗菌药物耐药性分析

Distribution of pathogens and antimicrobial resistance in ascites samples from 2015 to 2019

目的分析2015—2019年云南省第二人民医院住院患者腹腔积液标本病原菌分布及抗菌药物耐药性,指导临床合理选用抗菌药物。方法回顾性分析本院2015—2019年收集的腹腔积液标本(1254份)分离的病原菌分布及药敏试验结果。结果1254份腹腔积液标本共分离出非重复病原菌687株,总检出率为54.78%,在687株病原菌中主要是革兰阴性菌,最常见的是大肠埃希菌和肺炎克雷伯菌,其次是以屎肠球菌和表皮葡萄球菌为主的革兰阳性菌;真菌占10.19%,最多见的是白色念珠菌。革兰阴性菌检出率由2016年的79.82%下降至2019年的53.21%,呈现明显下降趋势(P<0.05),革兰阳性菌检出率由2016年的20.18%上升至2019年的46.79%,呈现明显上升趋势(P<0.05)。科室主要来源于普通外科,占61.3%、ICU占23.8%。产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的检出率分别为64.09%、43.48%,产ESBLs的大肠埃希菌和肺炎克雷伯菌对青霉素类、第一代和第三代头孢菌素耐药率均在90%以上,大肠埃希菌和肺炎克雷伯菌对碳青霉烯类耐药率不超过50%,但不产ESBLs的肺炎克雷伯菌相比产ESBLs的肺炎克雷伯菌对碳青霉烯类抗生素反而耐药率偏高。结论革兰阴性菌是本院腹腔积液标本分离的主要病原菌,尤其是产ESBLs的大肠埃希菌和肺炎克雷伯菌检出率高,而且产ESBLs容易出现假阴性现象,可能与同时产碳青霉烯酶有关,产ESBLs对常见抗菌药物耐药率均有较高耐药率,合理选用抗菌药物的同时也要加强耐药菌株的监测,防止院内感染暴发流行。

Objective To analyze the distribution of pathogenic bacteria and antimicrobial resistance in peritoneal effusion samples of hospitalized patients in the Second People’s Hospital of Yunnan Province from 2015 to 2019,and to guide clinical rational use of antimicrobial agents.Methods The results of pathogenic bacteria distribution and in vitro drug sensitivity test of ascites specimen(1254 cases)collected in our hospital from 2015 to December 2019 were retrospectively analyzed.Results 687 strains of non repetitive pathogens were isolated from 1254 samples of ascites,the total detection rate was 54.78%.Among the 687 strains of pathogens,the most common were Escherichia coli and Klebsiella pneumoniae,followed by Enterococcus faecium and Staphylococcus epidermidis;fungi accounted for 10.19%,the most common was Candida albicans.The detection rate of Gram-negative bacteria decreased from 79.82%in 2016 to 53.21%in 2019,showing a significant downward trend(P<0.05),and the detection rate of Gram-positive bacteria increased from 20.18%in 2016 to 46.79%in 2019,showing a significant upward trend(P<0.05).61.3%of the departments came from general surgery and 23.8%from ICU.The detection rates of ESBLs producing Escherichia coli and Klebsiella pneumoniae were 64.09%and 43.48%respectively.The resistance rates of ESBLs producing Escherichia coli and Klebsiella pneumoniae to penicillins,the first and third generation cephalosporins were more than 90%.The resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems were less than 50%,but the resistance rates of non ESBLs producing Klebsiella pneumoniae were higher than those of ESBLs producing Klebsiella pneumoniae.On the contrary,the drug resistance rate of Klebsiella pneumoniae to carbapenems was higher.Conclusion Gram negative bacteria are the main pathogens isolated from peritoneal effusion samples in our hospital,especially ESBLs producing Escherichia coli and Klebsiella pneumoniae,and ESBLs producing bacteria are prone to false negative phenomenon.Laboratory staff should pay high attention to the high drug resistance rate of ESBLs producing bacteria to common antibiotics,and reasonable selection of antibiotics.At the same time,we should strengthen the monitoring of drug-resistant strains to prevent the outbreak of nosocomial infection.