四川省细菌耐药监测网2016—2020年血流感染病原菌分布及耐药分析

Analysis of Distribution and Drug Resistance of Pathogens in Bloodstream Infections in Sichuan Antibiotics Resistance Monitoring Network from 2016 to 2020

目的统计分析四川省细菌耐药监测网成员单位2016—2020年度血流感染病原菌分布及耐药情况,为四川省医疗机构药物合理应用提供依据。方法采用四川省细菌耐药监测网数据合格的86家成员单位,2016—2020年住院和门诊患者临床血液标本中分离的非重复病原菌,用标准纸片扩散法或自动化仪器检测法,测定监测药物对细菌的敏感性,并依据美国临床和实验室标准协会(CLSI)2020年标准,使用WHONET 5.6版软件进行数据统计分析。结果从血液标本中分离出病原菌84232株,其中革兰阴性菌49523株(58.8%),革兰阳性菌34709株(41.2%),检出率前5位的菌依次是大肠埃希菌(33.9%)、肺炎克雷伯菌(11.0%)、表皮葡萄球菌(9.3%)、金黄色葡萄球菌(6.8%)、人葡萄球菌(6.5%)。大肠埃希菌、肺炎克雷伯菌对碳青霉烯类药物仍高度敏感,耐药率低于7.3%,耐碳青霉烯类大肠埃希菌、肺炎克雷伯菌检出率分别为1.0%,5.9%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)检出率分别为25.5%和71.7%,MRSA和MRCNS对大多数检测药物的耐药率均高于甲氧西林敏感株(MSSA和MSCNS),未发现万古霉素和利奈唑胺耐药株。肠球菌主要以屎肠球菌、粪肠球菌为主,两者对万古霉素、利奈唑胺的耐药率呈逐年递减趋势。结论血液标本病原菌多样化,革兰阴性菌占比稍高,临床应参考药敏结果,结合临床选择抗菌药物,以获取最佳临床疗效。

Objective To analyze the distribution and drug resistance of pathogens isolated from bloodstream infections in patients of the member units of Sichuan bacterial resistance monitoring network from 2016 to 2020,and to provide the basis for the rational use of drugs in medical institutions in our province.Methods Non-repetitive pathogens isolated from clinical blood samples of inpatients and outpatients from 86 member units with qualified data from 2016 to 2020 were obtained from the Sichuan Province Antimicrobial Resistance Surveillance System.Identification and antimicrobial susceptibility analysis were carried out by Vitek2 Compact and standard disc diffusion method,and the results were determined according to the CLSI 2020 with data analyzed with WHONET 5.6 software.Results Total 84232 pathogenic bacteria were isolated from the blood samples,including 49523 Gram-negative bacteria(58.8%)and 34709 Gram-positive bacteria(41.2%).The top five most frequently isolated pathogens were Escherichia coli(33.9%),Klebsiella pneumoniae(11.0%),Staphylococcus epidermis(9.3%),Staphylococcus aureus(6.8%),and Staphylococcus hominis(6.5%).Escherichia coli and Klebsiella pneumoniae were still highly sensitive to carbapenems,and the resistance rate was less than 7.3%.The resistant rates of Escherichia coli and Klebsiella pneumoniae to carbapenems were 1.0%and 5.9%,respectively.The detection rates of methicillin-resistant in Staphylococcus aureus and in coagulase-negative Staphylococcus aureus were 25.5%and 71.7%,respectively,and MRSA and MRCNS were highly resistant to common antibiotics than methicillin-sensitive strains(MSSA and MSCNS),and resistant strains to vancomycin and linezolid were not isolated.The two most frequently isolated Enterococcus were Enterococcus faecium and Enterococcus faecalis,and resistance rate to vancomycin and linezolid were decreasing every year.Conclusion The pathogens isolated from blood were diverse,and Gram-negative bacteria were the main pathogens of BSI.Antimicrobial therapy should be prescribed according to the drug sensitivity results,and should be used more rationally to obtain a better effect.