急诊科临床分离的病原菌分布及耐药性分析

Analysis of distribution and drug resistance of pathogenic bacteria isolated clinically in emergency department

目的了解北京大学首钢医院急诊科的病原菌分布和抗菌药物的耐药现状。方法回顾性分析北京大学首钢医院急诊科2018年1月至2020年12月病原菌的分布和药敏结果,采用WHONET5.6软件进行数据分析。结果共分离出875株病原菌,其中革兰阴性菌占73.50%,革兰阳性菌占21.70%,真菌占4.80%。前5位的病原菌依次是铜绿假单胞菌(20.60%),大肠埃希菌(18.60%),肺炎克雷伯菌(16.30%),鲍曼不动杆菌(9.80%)和金黄色葡萄球菌(5.40%)。产ESBL大肠埃希菌和肺炎克雷伯菌的检出率分别是42.60%和48.80%。CRE中耐碳青霉烯大肠埃希菌和肺炎克雷伯菌的检出率分别是4.90%和28.00%。泛耐药鲍曼不动杆菌的检出率是81.40%。MRSA的检出率是42.90%,MRCNS的检出率是64.20%,未发现对万古霉素和利奈唑胺耐药的菌株。VRE中耐万古霉素粪肠球菌和屎肠球菌的检出率分别为4.80%和11.10%。未发现对利奈唑胺和替考拉宁耐药的肠球菌。结论急诊科常见病原菌对抗菌药物的耐药情况严重,临床应在经验性抗感染治疗的同时,积极对病原学标本进行药敏试验,减少耐药的发生。

Objective To investigate the distribution of pathogenic bacteria and the current status of resistance to antimicrobial drugs in the emergency department of Peking University Shougang Hospital.Methods The distribution of pathogenic bacteria and drug susceptibility results in the emergency department of Peking University Shougang Hospital from January 2018 to December 2020 were retrospectively analyzed,and WHONET5.6 software was utilized for data analysis.Results A total of 875 pathogenic bacteria were isolated,of which gram-negative bacteria accounted for 73.50%,gram-positive bacteria accounted for 21.70%,and fungi accounted for 4.80%.The top 5 pathogens are Pseudomonas aeruginosa(20.60%),Escherichia coli(18.60%),Klebsiella pneumoniae(16.30%),Acinetobacter baumannii(9.80%)and Staphylococcus aureus(5.40%).The detection rates of ESBL-producing Escherichia coli and Klebsiella pneumoniae were 42.60%and 48.80%,respectively.The detection rates of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae in CRE were 4.90%and 28.00%,respectively.The detection rate of pan-drug resistant Acinetobacter baumannii was 81.40%.The detection rates of MRSA and MRCNS were 42.90%and 64.20%.No strains resistant to vancomycin and linezolid were found.The detection rates of vancomycin-resistant Enterococcus faecalis and Enterococcus faecium in VRE were 4.80%and 11.10%,respectively.No enterococci resistant to linezolid and teicoplanin were found.Conclusion The common pathogens in the emergency department have serious resistance to antimicrobial drugs.In clinical practice,drug susceptibility tests should be carried out actively on the pathogenic specimens in the course of empirical anti-infection treatment to reduce the occurrence of drug resistance.