2017~2020年玉林市新生儿呼吸道感染病原菌分布及耐药性分析

Analysis of distribution and drug resistance of pathogens causing neonatal respiratory tract infection in Yulin from 2017 to 2020

目的分析2017~2020年玉林市新生儿呼吸道感染患者的病原菌的分布及耐药性。方法采用自动化仪器MIC法、纸片扩散法(KB法)对临床分离株进行药敏试验,并按2017年CLSI标准判断药敏试验结果,采用WHONET 5.6软件,对玉林市7家二级以上医院呼吸道标本分离菌作前瞻性统计分析。结果2017~2020年7家医院呼吸道标本共分离出1400株细菌,革兰阴性菌占82.71%,革兰阳性菌占16.86%。常见细菌依次为肺炎克雷伯菌(45.07%)、大肠埃希菌(18.71%)、金黄色葡萄球菌(13.29%)、鲍曼不动杆菌(6.14%)、铜绿假单胞菌(3.64%)、阴沟肠杆菌(1.79%)、无乳链球菌(1.93%)、嗜麦芽黄单胞菌(1.50%)等。药敏结果显示金黄色葡萄球菌对青霉素耐药率高达67.20%,对红霉素的耐药率为58.60%,对克林霉素耐药率为24.73%。MRSA检出率为65.05%。发现耐万古霉素耐药株3株。无乳链球菌对青霉素、氨苄西林类等100%敏感,对克林霉素耐药率为25.93%,对左氧氟沙星、环丙沙星的耐药率分别为18.52%、14.81%。肺炎克雷伯菌、大肠埃希菌对氨苄西林耐药率分别为75.59%和61.45%,肺炎克雷伯菌对头孢他定、头孢噻肟、头孢唑啉耐药率为63%以上,对碳青霉烯类耐药率为52%左右。大肠埃希菌头孢唑林、哌拉西林耐药率分别为37.02%和40.08%,对碳青霉烯类、酶抑制剂复合制剂的耐药率在2%以下。鲍曼不动杆菌对酶抑制剂复合制剂耐药率为55%,对碳青霉烯类药物耐药率在60%左右,对头孢他啶、头孢吡肟、头孢曲松耐药率在53%~67%。铜绿假胞菌对对氨苄西林耐药率为74.51%,对碳青霉烯类、氨曲南耐药率小于6.0%。结论新生儿呼吸道分离菌以阴性杆菌为主,耐碳青霉烯类杆菌居多,肺炎克雷伯菌、鲍曼不动杆菌呈多重、高水平耐药,临床应重视耐药监测结果,合理使用抗菌药物。

Objective To analyze the distribution and drug resistance of pathogens in patients with neonatal respiratory tract infection in Yulin from 2017 to 2020.Methods Automatic instrument mic method and disk diffusion method(KB method)were used for drug sensitivity test of clinical isolates,and the results of drug sensitivity test were judged according to CLSI standard in 2017.WHONET 5.6 software was used for prospective statistical analysis of bacteria isolated from respiratory tract samples from 7 secondary or above hospitals in Yulin city.Results From 2017 to 2020,1400 strains of bacteria were isolated from respiratory specimens of 7 hospitals,among which gram-negative bacteria accounted for 82.71%and Gram-positive bacteria accounted for 16.86%.Common bacteria in order were Klebsiella pneumoniae(45.07%),Escherichia coli(18.71%),Staphylococcus aureus(13.29%),Acinetobacter baumannii(6.14%),Pseudomonas aeruginosa(3.64%),Enterobacter cloacae(1.79%),Streptococcus agalactiae(1.93%),and Xanthomonas maltophilia(1.50%).The results of drug sensitivity showed that the resistance rate of Staphylococcus aureus to penicillin was 67.20%,the resistance rate to erythromycin was 58.60%,and the resistance rate to clindamycin was 24.73%.The detection rate of MRSA was 65.05%.Three vancomycin resistant strains were found.Streptococcus agalactiae was 100%sensitive to penicillin and ampicillin,and the resistance rate of it to clindamycin was 25.93%,and the resistance rates to levofloxacin and ciprofloxacin were 18.52%and 14.81%,respectively.The resistance rates of Klebsiella pneumoniae and Escherichia coli to ampicillin were 75.59%and 61.45%,respectively.The resistance rate of Klebsiella pneumoniae to ceftazidime,cefotaxime and cefazolin was more than 63%,and the resistance rate to carbapenems was about 52%.The resistance rates of cefazolin and piperacillin of Escherichia coli were 37.02%and 40.08%,respectively,and the resistance rate to the compound preparation of carbapenems and enzyme inhibitor was below 2%.The resistance rate of the compound preparation of Acinetobacter baumannii to enzyme inhibitor was 55%,to carbapenems was about 60%,and to ceftazidime,cefepime and ceftriaxone was 53%-67%.The resistance rate of Pseudomonas aeruginosa to ampicillin was 74.51%,and to carbapenems and aztreonam was below 6.0%.Conclusion Isolated bacteria from neonatal respiratory tract bacteria are mainly negative bacilli,and most of them are carbapenem resistant bacilli.Klebsiella pneumoniae and Acinetobacter baumannii show multiple and high-level drug resistance,so the monitoring results of drug resistance should be paid attention to during clinical practice and antibiotics should be rationally used.