2020年医院感染大肠埃希菌耐药性差异化分析

Differentiation Analysis of Drug Resistance of Escherichia Coli Isolated From Nosocomial Infection in 2020

目的 回顾性分析临床分离大肠埃希菌的耐药性,比较不同来源分离临床菌株耐药性差异性,更精准全面了解该菌耐药性,为临床合理有药提供有效参考。方法 回顾性分析2020年临床分离大肠埃希菌,采用法国BioMerieux VITEK2 Compact全自动细菌鉴定及药敏分析系统对菌株进行细菌鉴定和药物敏感性检测,并用Excel软件进行数据分析。结果 2020年临床分离的大肠埃希菌1 614株,其中尿液标本分离最多(58.7%),依次是体液(包括胆汁、腹水、胸腔积液、关节液等)、全血和痰液;科室来源门急诊分离最多(30.3%),ICU分离相对不多(8.2%);产ESBLs菌株710株占44.0%,不产ESBLs菌株890株占55.1%,其余有14株占0.9%;ICU产ESBLs菌株阳性率最高(58.7%),全血分离菌株产ESBLs较低(38.8%),大肠埃希菌仍保持对亚胺培南极高敏感性,敏感率在98.9%(1 597/1 614),从标本来源,除了全血未分离耐碳青霉烯类菌株,其他标本均可检出,耐碳青霉烯类菌株主要来自ICU和妇产科,门急诊患者也可检出;对头孢噻肟和头孢他啶敏感率分别是56.4%(910/1 614)和79.2%(1 279/1 614),ICU对头孢噻肟的敏感率只有37.6%(50/133),体液和痰液标本来源均低于50%;对3种酶抑制剂组合(哌拉西林/他唑巴坦、阿莫西林/克拉维酸钾、氨苄西林/舒巴坦)的敏感率分别是92.3%(1 489/1 614)、76.8%(1240/1 614)和35.3%(569/1 614);对大多数抗菌药物,ICU和妇产科敏感性均相对比较低,全血敏感性最好而痰液最差;对左氧氟沙星的敏感率46.3%(748/1 614),ICU和内科敏感性均接近40%,尿液来源敏感性最差已接近40%;对氨曲南和阿米卡星敏感率分别是72.8%(1 175/1 614)和95.8%(1 547/1614)。结论 大肠埃希菌虽然对亚胺培南敏感性极度敏感,耐碳青霉烯类菌株在临床呈上升的趋势,尤其来自ICU分离菌株对抗生素敏感性均较差,产ESBLs菌株也比较高;另外对于外科感染经验性用药和预防用药,较高产ESBLs菌株也不容忽视;从标本类型分析,不同标本分离的菌株之间还是有所差别,临床用药时也应重视其差异性。

Objective To retrospectively analyze the drug resistance of clinical isolates of Escherichia coli(E.coli)and compare the drug resistance differences of clinical isolates from different sources,so as to more accurately and comprehensively understand the drug resistance of Escherichia coli and provide effective reference for clinical rational drug use.Methods Clinical isolates of Escherichia coli in 2020 were retrospectively analyzed.The strains were identified and drug sensitivity detected by the French bioMerieux VITEK2 Compact automatic bacterial identification and drug sensitivity analysis system,and the data were analyzed by Excel software.Results In 2020,1614 strains of E.coli were clinically isolated,urine specimens were the most isolated(58.7%),followed by body fluid(including bile,ascites,pleural effusion,joint fluid,etc.),whole blood and sputum.The isolates from outpatient and emergency departments accounted for the most(30.3%),and the isolates from ICU were relatively less(8.2%).There were 710 ESBLs producing strains(44.0%),890 non ESBLs producing strains(55.1%),and the remaining were 14 strains(0.9%).The positive rate of ESBLs producing strains from ICU was the highest(58.7%),and the ESBLs producing strains isolated from whole blood was low(38.8%).E.coli remained highly sensitive to imipenem,with a sensitivity rate of 98.9%(1597/1614).From the source of specimens,Carbapenem-resistant strains could be detected in all specimens except the whole blood.Carbapenem-resistant strains were mainly from ICU and obstetrics and gynecology department,and could also be detected in outpatient and emergency patients..The sensitivity rates to cefotaxime and ceftazidime were 56.4%(910/1614)and 79.2%(1279/1614),respectively.The sensitivity rate to cefotaxime in ICU was only 37.6%(50/133),and the sources of body fluid and sputum samples were less than 50%.The susceptibility rates of the three enzyme inhibitor combinations(piperacillin/tazobactam,amoxicillin/potassium clavulanate,ampicillin/sulbactam)were 92.3%(1489/1614),76.8%(1240/1614)and 35.3%(569/1614),respectively.For most antibiotics,the sensitivity of isolates from ICU and obstetrics and gynecology department were relatively 1ow,the sensitivity of isolates from whole blood was the best,and the sensitivity of isolates from sputum was the worst.The sensitivity rate to levofloxacin was 46.3%(748/1614),the sensitivity of isolates from ICU and internal medicine was nearly 40%,and the sensitivity of isolates from urine was the worst,nearly 40%.The sensitivity rates to aztreonam and amikacin were 72.8%(1175/1614)and 95.8%(1547/1614),respectively.Conclusion Although Escherichia coli is extremely sensitive to imipenem,carbapenem-resistant strains are on the rise in clinical practice,especially the strains isolated from ICU are less sensitive to antibiotics,and the strains producing ESBLs are also higher.In addition,high yield ESBLs strains should not be ignored for empiric and prophylactic drugs for surgical infections.From the analysis of specimen type,the strains isolated from different specimens are still different,which should be paid attention to in clinical use.