某综合医院烧伤住院患者感染病原菌分布及耐药性变迁

Changes of distribution and drug resistance of pathogenic bacteria in burn inpatients in a general hospital

目的调查2015-2020年某综合医院烧伤住院患者感染病原菌分布特点及耐药性变迁。方法回顾分析重庆大学附属三峡医院2015-2020年烧伤科收治的已明确有感染的833例住院患者的临床资料,分析其常见感染病原菌类型与药敏结果,并将2015-2017年与2018-2020年主要病原菌检出率与耐药率进行对比,采用WHONET5.6软件和SPSS21.0软件进行数据处理及统计分析。结果2015-2020年共分离833株病原菌,其中革兰阴性杆菌503株(60.4%)、革兰阳性球菌323株(38.8%)、真菌7株(0.8%);检出最多的是金黄色葡萄球菌,为134株(16.1%),其次是大肠埃希菌,为108株(13.0%),随后是铜绿假单胞菌,为103株(12.4%),鲍曼不动杆菌65株(7.8%)居第4位。2015-2017年与2018-2020年比较,革兰阴性杆菌总检出率变化不显著;2018-2020年革兰阳性球菌尤其是金黄色葡萄球菌检出率明显下降,且有真菌检出。2018-2020年检出的3种主要革兰阴性杆菌耐药率中,大肠埃希菌和铜绿假单胞菌对碳青霉烯类抗菌药物最敏感,鲍曼不动杆菌对左氧氟沙星和复方磺胺甲噁唑最敏感。检出的3种主要革兰阳性球菌保持对万古霉素、利奈唑胺、奎奴普丁/达福普汀100.0%敏感,对部分抗菌药物耐药率呈上升趋势,其中金黄色葡萄球菌对庆大霉素、利福平、环丙沙星和左氧氟沙星耐药率明显增高,溶血葡萄球菌对庆大霉素、莫西沙星、环丙沙星和左氧氟沙星耐药率明显增高(P<0.05)。结论该院烧伤科住院患者感染病原菌以革兰阴性杆菌为主,与2015-2017年比较,2018-2020年大肠埃希菌替代铜绿假单胞菌成为第一优势菌,对常用抗菌药物的耐药性均呈下降趋势;革兰阳性球菌尤其是金黄色葡萄球菌检出率下降,但其对庆大霉素、喹诺酮类抗菌药物的耐药性增加,因此,临床需结合感染病原学合理选择抗菌药物。

Objective To investigate the distribution characteristics and drug resistance changes of pathogenic bacteria in burn inpatients in a general hospital from 2015 to 2020.Methods The clinical data of hospitalized patients with definite infection admitted to Department of Burn of Chongqing University Three Gorges Hospital from 2015 to 2020 were retrospectively analyzed.The types of common pathogenic bacteria and drug sensitivity results were analyzed.The detection rate and drug resistance rate of main pathogenic bacteria in 2015-2017 and 2018-2020 were compared.WHONET 5.6 Software analysis and SPSS21.0 software were used for data processing and statistical analysis.Results A total of 833 pathogenic bacteria were isolated from 2015 to 2020,including 503 strains of Gram-negative bacilli(60.4%),323 strains of Gram-positive cocci(38.8%)and 7 strains of fungi(0.8%).The highest detection rate was 134 strains of Staphylococcus aureus(16.1%),followed by 108 strains of Escherichia coli(13.0%)and 103 strains of Pseudomonas aeruginosa(12.4%),and 65 strains of Acinetobacter baumannii(7.8%)ranked the fourth.Compared with 2015-2017,the total isolation rate of Gram-negative bacilli in 2018-2020 had no significant fluctuation.In 2018-2020,the drug detection rate of Gram-positive bacteria,especially Staphylococcus aureus,decreased significantly,and fungi were detected.In the drug resistance rates of the three major Gram-negative bacilli detected in 2018-2020,Escherichia coli and Pseudomonas aeruginosa were the most sensitive to carbapenem antibiotics,and Acinetobacter baumannii was the most sensitive to levofloxacin and compound sulfamethoxazole.The three main Gram-positive cocci detected remained 100.0%sensitive to vancomycin,linezolid,quinupristin/dalfopristin,and the drug resistance rate to other antibiotics showed an upward trend.The drug resistance rates of Staphylococcus aureus to gentamicin,rifampicin,ciprofloxacin and levofloxacin increased significantly,and the drug resistance rates of hemolytic Staphylococcus to gentamicin,moxifloxacin,ciprofloxacin and levofloxacin increased significantly(P<0.05).Conclusion Gram-negative bacilli are the main pathogens of infection in hospitalized patients in Department of Burn in the hospital.Compared with 2015-2017,Escherichia coli replaces Pseudomonas aeruginosa as the first dominant bacteria in 2018-2020,and the drug resistance to commonly used antibiotics shows a downward trend.The detection rate of Gram-positive bacteria,especially staphylococcus aureus decrease,but its drug resistance to gentamicin and quinolones increases.Therefore,antibiotics should be reasonably selected in clinical practice combined with infection etiology.