2015年-2021年浙江地区某肿瘤医院无菌体液的耐药变迁

Changes of drug resistance of sterile body fluid samples in a cancer hospital in Zhejiang Province from 2015 to 2021

目的了解中国科学院大学附属肿瘤医院住院患者2015年1月—2021年12月无菌体液标本的耐药变迁。方法采用自动化仪器和标准纸片扩散法,依据美国临床实验室标准化研究协会(CLSI)2020年标准,采用WHONET5.6软件进行统计分析。结果无菌体液标本主要来自腹水(53.21%),其次为引流液(24.34%),病区主要来自外科病房,共分离出4400株非重复的病原菌,其中阴性菌占50.66%,阳性菌占42.07%,真菌占7.27%。无菌体液中前3位的病原菌是大肠埃希菌、粪肠球菌、金黄色葡萄球菌。产超广谱内酰胺酶(ESBL)的大肠埃希菌和肺炎克雷伯菌的检出率最高为75.2%和35.5%,对碳青霉烯类药物耐药率低;耐甲氧西林金黄色葡萄球菌(MRSA)检出率最高为53.1%,未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌和粪肠球菌。结论浙江地区肿瘤患者无菌体液分离的病原菌分布广泛,不同病原菌耐药谱不同,应合理选择抗生素,避免抗生素的滥用。

Objective To investigate the changes of drug resistance in sterile body fluid samples of inpatients in Cancer Hospital of University of Chinese Academy of Sciences from January 2015 to December 2021.Methods The drug resistance was detected by automatic instruments and standard disk diffusion method according to the 2020 standard of CLSI,and statistical analysis was performed using WHONET5.6 software.Results Ascites(53.21%)was the main source of sterile body fluid,followed by drainage fluid(24.34%),and surgical ward was the main source of disease area.4400 strains of non-repeating pathogens were isolated,among which negative bacteria accounted for 50.66%,positive bacteria accounted for 42.07%,and fungi accounted for 7.27%.The top three pathogenic bacteria in sterile body fluids wereEscherichia coli,Enterococcus faecalis andStaphylococcus aureus.The rate of ESBL-producingEscherichia coliandKlebsiella pneumoniaewas 75.2%and 35.5%,and the drug resistance rate of carbapenem was low.The highest detection rate ofMethicillin-resistant Staphylococcus aureus(MRSA)was 53.1%.No Staphylococcus andEnterococcus faecalisresistant to vancomycin,teicoranin and linezolid was found.Conclusion Pathogenic bacteria isolated from sterile body fluids of inpatients with cancer in Zhejiang are widely distributed.Different pathogenic bacteria have different drug resistance spectrum.Antibiotics should be rationally selected to avoid the abuse of antibiotics.