2018—2021年临床常见胆道感染病原菌分布及耐药性变迁

Distribution and Drug Resistance Change of Pathogens in Biliary Tract Infection from 2018 to 2021

目的:分析2018—2021年我院胆道感染患者病原菌构成及耐药性变迁。方法:收集2018—2021年天津市南开医院胆道感染病原菌,采用VITEK2 Compact对其进行鉴定及药敏检测,药敏结果按照CLSI 2020年版标准判定,数据采用WHONET 5.6软件进行统计分析。结果:胆汁培养共分离出病原菌4906株,其中革兰阴性菌3306株,占67.39%;革兰阳性菌1494株,占30.45%;真菌106株,占2.16%。耐碳青霉烯的大肠埃希菌、肺炎克雷伯菌检出率分别为2.31%、12.99%。非发酵菌中碳青霉烯类耐药的铜绿假单胞菌(CRPA)和鲍曼不动杆菌(CRAB)检出率分别为62.88%、70.59%。耐甲氧西林的金黄色葡萄球菌(MRSA)和耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)检出率分别为45.71%、64.40%,未发现对万古霉素、喹努普汀/达福普汀、利奈唑胺、替加环素耐药的葡萄球菌属。肠球菌对万古霉素、利奈唑胺和替加环素的耐药性均较低,万古霉素耐药的屎肠球菌(VRE)检出率0.67%。结论:胆道感染患者病原菌以肠源性细菌为主,主要为革兰阴性菌,多重耐药菌增加,应密切关注胆道感染常见菌群的分布及耐药性变迁。

Objective To analyze the distribution and drug resistance of pathogens isolated from biliary tract infections from 2018 to 2021.Methods The bile culture samples in TianJin NanKai Hospital between 2018 and 2021 were collected,bacterial identification and antimicrobial susceptibility test were carried out by VITEK 2 Compact,the results were interpreted according to CLSI(2020)breakpoints,and the dada was analyzed by WHONET 5.6.Results A Total of 4906 strains of pathogenic bacteria were isolated from the bile samples,including 3306 strains of Gram-negative bacteria(67.39%),1494 strains of Gram-positive bacteria(30.45%)and 106 strains of fungi(2.16%).The resistant rates of Escherichia coli and Klebsiella pneumoniae to carbapenems were 2.31%and 12.99%,respectively.Among non-fermentative bacteria,Pseudomonas aeruginosa(CRPA)and Acinetobacter baumannii(CRAB),the resistant rates were 62.88%and 70.59%.The detection rates of methicillin-resistant in Staphylococcus aureus and in coagulase-negative Staphylococcus spp.were 45.71%and 64.40%,respectively,and vancomycin-,Quinuptine/Dauptine-,linezolid-and tegacycline-resistant Staphylococcus spp.was not found.Resistance of enterococcus to vancomycin,tegacycline and linezolid were all low,the detection rate of vancomycin-resistant Enterococcus faecium(VRE)was 0.67%.Conclusion The most common pathogens in biliary tract infection were intestinal,and most of them were the Gram-negative bacteria.The multi-drug resistant bacteria has increased,and therefore calls for concerted efforts aimed at resistant organisms and dynamic surveillance.