宁夏某院2011—2020年血标本病原菌的分布及耐药性变迁

Distribution and Drug Resistance of Pathogen in Blood Samples from A Hospital in Ningxia from 2011 to 2020

目的 了解某院2011—2020年血标本分离病原菌的分布及耐药性变迁,为血流感染的初始经验治疗提供理论依据。方法 将某院住院患者2011—2020年血标本分离细菌药敏结果分两个时间组,即2011—2015年组和2016—2020年组进行回顾性统计分析。结果 分离出的7515株非重复病原菌中,革兰阴性菌5097株(占67.8%),革兰阳性菌2418株(占32.2%)。排名前10位病原菌依次是大肠埃希菌、布鲁菌属、肺炎克雷伯菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌、屎肠球菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌和粪肠球菌。与2011—2015年相比,2016—2020年前10位病原菌中,大肠埃希菌、布鲁菌属和肺炎克雷伯菌占比明显增加,而鲍曼不动杆菌和凝固酶阴性葡萄球菌的占比明显下降。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率显著下降,由49.6%下降至26.7%;耐甲氧西林凝固酶阴性葡萄球菌(MRSCNs)的检出率维持在86.2%~88.8%;屎肠球菌对大部分测试药物的耐药率高于粪肠球菌,屎肠球菌对万古霉素的耐药率始终保持在1%左右,未检出耐万古霉素的粪肠球菌。2011—2015年未检出亚胺培南耐药的大肠埃希菌和肺炎克雷伯菌,但2016—2020年大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率分别增加至1.2%和3.9%。阴沟肠杆菌对所有测试药物的耐药性均保持稳定,对哌拉西林/他唑巴坦、亚胺培南、阿米卡星、环丙沙星和左氧氟沙星耐药率<10%。与2011—2015年相比,2016—2020年铜绿假单胞菌对亚胺培南耐药率显著下降,由17.4%下降至8.3%,鲍曼不动杆菌对亚胺培南的耐药率维持在76%左右。结论 该医院血流感染病原菌以革兰阴性菌为主,碳青霉烯类耐药肠杆菌科细菌显著增加,鲍曼不动杆菌对所测抗菌药物的耐药率依然很高,因此加强抗菌药物合理应用及医院感染的防控手段仍然势在必行。

Objective To investigate the distribution and changing pattern of susceptibility of clinical bacteria isolated from blood culture and to provide basis for rational clinical drug use.Methods Analyzed the antibacterial susceptibility data of blood samples in two time groups,2011—2015 and 2016—2020.Results 7515 non-repetitive pathogens were isolated,of which,5097 (67.8%) were Gram-negative bacteria and 2418 (32.2%) were Gram-positive bacteria.The top 10 bacterial species were Escherichia coli,Brucella spp,Klebsiella pneumoniae,Coagulase negative staphylococcus,Staphylococcusaureus,Enterococcus faecium,Pseudomonas aeruginosa,Enterobacter cloacae and Enterococcus faecalis.Compared with the years of 2011 to 2015,a significantly higher proportion of E.coli,Brucella spp and K.pneumoniae,and a significantly lower proportion of Acinetobacter baumannii and Coagulase negative staphylococcus were found from the year 2016 to 2019 (P<0.05).Methicillin-resistant Staphylococcus aureus (MRSA) were decreased from 49.6% to 26.7% and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) were accounted 86.2%~88.8%.The drug resistance rates of Enterococcus faecium to most of the tested drugs were higher than that of Enterococcus faecalis,and the resistance rate of Enterococcus faecium to vancomycin remained at about 1%.No vancomycin resistant Enterococcus faecalis was detected.Compared with the period from 2011 to 2015,the resistance rates of Escherichia coli and K.pneumonia to imipenem were increased 1.2% and 3.9%,respectively.Resistance of Enterobacter Cloacae to all tested drugs remained stable,to piperacillin/tazobactam,imipenem,amikacin,ciprofloxacin and levofloxacin were <10%.The drug resistance rates of Pseudomonas aeruginosa to imipenem decreased from 17.4% to 8.3%.The resistance rates of Acinetobacter baumannii to imipenem were 76%.Conclusion Gram-negative bacteria were the main pathogens of bloodstream infection in our hospital.CRE had a high detection rate and Acinetobacter baumannii had higher resistance.It is imperative to strengthen the management of antibiotic application and the prevention and control of nosocomial infection.