广西某医院2017—2021年艾滋病患者血培养病原菌调查及耐药性分析

Investigation and drug resistance analysis of pathogenic bacteria in blood culture of AIDS in a hospital in Guangxi, 2017-2021

目的 探讨艾滋病患者血培养阳性病原菌种类、构成及耐药性,为临床对艾滋病机会性感染的诊断和治疗提供实验室诊断依据。方法 回顾性统计本院2017—2021年艾滋病患者血培养病原菌种类、构成和药物敏感试验数据,用WHONET 5.6软件进行数据分类整理分析。结果 共送检5 125人次,分离出1 060株菌,阳性检出率为20.68%,真菌类为7种占比75.94%、细菌类52种占比为24.06%;细菌种类中革兰阳性球菌为34.12%,革兰阴性杆菌为63.88%。病原菌排前五位的是马尔尼菲篮状菌(64.25%),新生隐球菌(10.94%),沙门菌属(5.47%)、大肠埃希菌(4.72%)和金黄色葡萄球菌(3.87%)。药敏结果:金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(Methicillin resistant Staphylococcus aureus, MRSA)分离率为9.8%,凝固酶阴性葡萄球菌中耐甲氧西林凝固酶阴性葡萄球菌(Methicillin resistant Coagulasenegative Staphylococci, MRCNS)分离率为60.9%,复方新诺明和利福平耐药率明显升高;耐碳青霉烯革兰阴性杆菌除了检出鲍曼不动杆菌外其他菌属均未检出;新生隐球菌药敏试验结果显示总的MIC值处于较低水平。结论 艾滋病患者血培养菌群以真菌为优势,主要为马尔尼菲篮状菌和新生隐球菌;细菌中分离率依次为沙门菌属、金黄色葡萄球菌和大肠埃希菌等,并发现少见菌如马红球菌、NTM和诺卡菌等,因此艾滋病机会性感染病原体有其独特性。对优势菌株药物敏感结果分析结果:敏感菌株占优势,多重耐药菌株占比偏低,而葡萄球菌属对复方新诺明和利福平耐药率明显升高,为临床控制感染和合理规范使用抗菌药物提供参考依据。

Objective To explore the pathogenic species, constituent ratio and drug resistance in AIDS with positive blood cultures, and to provide laboratory diagnostic basis for the diagnosis and treatment of opportunistic infection of AIDS.Methods The pathogenic species, constituent ratio and drug resistance in AIDS with positive blood cultures were reviewed and analyzed in our hospital from 2017 to 2021, and the data consolidated by WHONET 5.6 software.ResultsA total of 5125 AIDS were tested and 1 060 strains were isolated. Positive blood cultures rate was 20.68%, the species of fungi and bacteria was 7(75.94%) and 52(24.06%). Gram-positive coccus and Gram-negative bacilli was 34.12% and 63.88%. The top five pathogenic bacteria were Talarmoyces marneffei(64.25%), Cryptococcus neoforrmans(10.94%), Salmonella(5.47%), Escherichia coli(4.72%) and Staphylococcus aureus(3.87%). Drug susceptibility test showed that the isolation rate of Methicillin resistant Staphylococcus aureus(MRSA) in Staphylococcus aureus was 9.8%, and that of Methicillin resistant Coagulase-negative Staphylococci(MRCNS) in coagulase negative staphylococcus was 60.9%. In addition, the resistance rate to cotrimoxazole and rifampicin increased significantly. Carbapenem-resistant Gram-negative bacilli were not found except Acinetobacter baumannii. Drug sensitivity test of Cryptococcus neoformans showed that the MIC was at a low level.ConclusionsFungi gets the bulge on the pathogenic specie in AIDS with positive blood cultures, mainly Talarmoyces marneffei and Cryptococcus neoformans. The isolation rates of bacteria were Salmonella, Staphylococcus aureus and Escherichia coli, respectively, and found rare bacteria such as Rhodococcus equi, Non-tuberculous mycobacteria and Nocardia, so the characteristics of the pathogen of AIDS opportunistic infection are unique. The drug sensitivity results showed that the sensitive strains were dominant, and the proportion of multiple drug resistant strains was low, while the drug resistance rates of Staphylococcus to cotrimoxazole and rifampicin were significantly increased, to provide reference for infection control and rational and standardized use of antibiotics.