2012—2021年某院脑脊液病原菌分布与耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria in cerebrospinal fluid in a hospital from 2012 to 2021

目的分析2012—2021年福建医科大学附属龙岩第一医院脑脊液培养分离菌的分布及耐药性变迁情况。方法回顾性分析该院10年间年脑脊液分离菌科室分布、菌群构成特点、药敏结果等分析。数据统计分析应用WHONET 5.6软件。结果10年间共分离病原菌804株(剔除重复菌株),其中革兰阳性菌666株,占82.84%;革兰阴性菌106株,占13.18%;真菌32株,占3.98%。居前7位的分别是凝固酶阴性葡萄球菌(coagulase negative staphylococcus,CNS)542株,占67.41%;肺炎链球菌37株,占4.60%;金黄色葡萄球菌33株,占4.10%;大肠埃希菌25株,占3.11%;新型隐球菌22株,占2.74%;肺炎克雷伯菌22株,占2.74%;鲍曼不动杆菌14株,占1.74%;葡萄球菌对万古霉素、利奈唑胺、替考拉宁的敏感率为100%,甲氧西林耐药金黄色葡萄球菌(methicillin resistant staphylococcus aureus,MRSA)和凝固酶阴性葡萄球菌(methicillin resistant coagulase negative staphylococcus,MRCNS)分别占各自菌的54.54%和75.65%。肺炎链球菌对左氧氟沙星、莫西沙星、利奈唑胺、万古霉素的敏感率为100%。检出5株碳青霉烯类耐药肠杆菌目细菌(carbapenem resistant enterobacteriaceae,CRE)。新型隐球菌对常用5种抗真菌药物敏感率>86.00%,鲍曼不动杆菌对常用抗菌药物耐药率>71.00%。结论革兰阳性球菌为脑脊液培养主要病原菌,MRCNS和MRSA的检出率较高,鲍曼不动杆菌对常用抗菌药物表现为泛耐药。加强脑脊液病原学和耐药性监测,对指导临床合理应用抗菌药物具有重要意义。

Objective To analyze the distribution and drug resistance of isolated bacteria cultured in cerebrospinal fluid from Longyan First Hospital affiliated to Fujian Medical University from 2012 to 2021.Methods This study retrospectively analyzed the department distribution,characteristics of bacterial community composition and drug sensitivity of isolated bacteria in cerebrospinal fluid in the hospital during the past 10 years.Statistical analysis was performed with software WHONET 5.6.Results A total of 804 strains of pathogenic bacteria were isolated during the past 10 years(excluding duplicate strains),with 666 strains of Gram-positive bacteria,accounting for 82.84%;106 strains of Gram-negative bacteria,accounting for 13.18%;32 strains of fungi,accounting for 3.98%.The top 7 were 542 strains of coagulase negative staphylococcus(CNS)(67.41%),37 strains of Streptococcus pneumoniae(4.60%);33 strains of Staphylococcus aureus(4.10%),25 strains of Escherichia coli(3.11%),22 strains of cryptococcus neoformans(2.74%),22 strains of Klebsiella pneumoniae(2.74%),14 strains of acinetobacter baumannii strains(1.74%).The sensitivity rate of Staphylococcus to vancomycin,linezolid and teicoranin was 100%.MRSA(Methicillin-resistant Staphylococcus aureus)and MRCNS(Methicillin resistant coagulase negative Staphylococcus)accounted for 54.54%and 75.65%of the bacteria respectively.The sensitivity rate of Streptococcus pneumoniae to levofloxacin,moxifloxacin,linezolid and vancomycin was 100%.Five strains of CRE(Carbapenem resistant Enterobacteriaceae)were detected.The susceptibility rate of Cryptococcus neoformans to 5 commonly used antifungal drugs was more than 86.00%,and the resistance rate of Acinetobacter baumannii to commonly used antifungal drugs was above 71.00%.Conclusion Gram-positive bacteria are the main pathogens in cerebrospinal fluid culture,the detection rate of MRCNS and MRSA is higher.Acinetobacter baumannii shows pan-resistance to commonly used antibacterial drugs.It is of great significance to strengthen the monitoring of drug resistance and the study of etiology of cerebrospinal fluid to guide the rational use of antibiotics in clinic.