2012—2020年广州地区肺炎链球菌耐药趋势增高及聚集性多重耐药模式

The increasing trend of drug resistance and aggregated multi-drug resistance model of Streptococcus pneumoniae in Guangzhou from 2012 to 2020

目的:分析2012—2020年广州地区肺炎链球菌抗菌药物耐药性的分布情况及聚集性多重耐药模式。方法:收集2012—2020年肺炎链球菌感染的临床数据;采用VITEK 2 Compact和MALDI-TOF/TOF MS进行初步鉴定,并用奥普托欣试验和胆汁溶血试验再次验证;采用VITEK 2 Compact和K-B法进行药敏谱分析,结果判读参照CLSI2020标准,数据采用WHONET5.6和SPSS23.0软件进行统计分析。结果:共收集1 110株肺炎链球菌,纳入分析753株非重复分离株,主要来源于痰液标本(73.7%)。感染患者中,男性偏多(69.7%),年龄段主要集中在≤5岁的婴幼儿及儿童(53.9%),科室分布以重症监护室为主(51.4%)。多重耐药的肺炎链球菌占总分离数的75.3%(567/753),多重耐药株分离率从2012年的66.7%(44/66)上升至2020年的93.9%(46/49),呈上升趋势(P <0.001)。美罗培南耐药率从27.9%(17/61)上升至58.7%(27/46),出现明显增长趋势(P <0.001);青霉素耐药率从70.0%(7/10)降低至18.4%(9/49),出现明显下降趋势(P <0.001);头孢噻肟从9.1%(1/11)上升至32.6%(15/46)(P=0.063),但其上升趋势不可忽略,需进一步监测;红霉素和四环素耐药率一直较高。多重耐药模式出现聚集性,最主要为A模式:四环素-复方磺胺甲恶唑-红霉素同时耐药,占27.3%(155/567),其他耐药模式均在A模式的基础上进一步发展。结论:多重耐药肺炎链球菌呈逐年递增趋势,美罗培南和头孢噻肟为重点监测药物,青霉素出现耐药减少趋势,可作为经验性治疗用药。聚集性耐药模式提示经验用药可能失败,地区性合理使用抗菌药物并定期进行耐药监测是长期任务。

Objective:This study aims to analyze the distribution of antimicrobial resistance and the mode of aggregated multi-drug resistance in Streptococcus pneumoniae isolates in Guangzhou from 2012 to 2020. Methods:The clinical data of Streptococcus pneumoniae infection from 2012 to 2020 were collected;the preliminary identification was carried out by VITEK 2 Compact and MALDI-TOF/TOF MS,and verified again by Optoxin test and bile hemolysis test;the drug sensitivity spectrum was analyzed by VITEK2 Compact and Kirby-Bauer method,the results were interpreted according to the CLSI2020 standard,and the data were statistically analyzed by WHONET5.6 and SPSS23.0 software. Results:A total of 1 110 strains were collected,of which 753 strains were included in the analysis,mainly from sputum samples(73.7%). Among the infected patients,the male was on the high side(69.7%),and the age group was mainly concentrated in infants and children ≤5 years old(53.9%),the distribution of departments was mainly concentrated in ICU(51.4%). Multidrug-resistant Streptococcus pneumoniae accounted for 75.3% of the total isolates(567/753),from 66.7%(44/66)in 2012 to 93.9%(46/49)in 2020,showing an upward trend(P < 0.001). The resistance rate of meropenem increased from 27.9%(17/61)to 58.7%(27/46),showing an obvious increasing trend(P < 0.001). The resistance rate of penicillin decreased from 70.0%(7/10)to 18.4%(9/49)(P < 0.001). Cefotaxime increased from 9.1%(1/11)to 32.6%(15/46)(P=0.063),but its upward trend can not be ignored and needs further monitoring. The resistance rates of erythromycin and tetracycline have been high. Multi-drug resistance mode appeared aggregation,the most important is mode A:tetracycline-compound sulfamethoxazole-erythromycin simultaneous resistance,accounting for 27.3%(155/567),other drug resistance modes are further developed on the basis of mode A. Conclusion:Multi-drug resistance of Streptococcus pneumoniae is increasing year by year,meropenem and cefotaxime are the key monitoring drugs,penicillin resistance tends to decrease,which can be used as empirical treatment. The mode of aggregate drug resistance suggests that it is possible to experience the failure of drug use,and regional rational use of antibiotics and regular monitoring of drug resistance is a long-term task.