2018~2021年医院尿培养病原菌及菌株耐药性变迁

Changes of pathogens and drug resistance of strains in hospital urine culture from 2018 to 2021

目的 分析秦皇岛市第一医院4年间尿培养病原菌分布情况及耐药菌株变迁情况,为尿路感染临床诊疗提供参考依据。方法 采用回顾性分析,以2018年1月~2021年12月期间收集的2 782株菌株为研究对象,菌株的鉴定和药敏试验采用Vitek2 Compact全自动微生物鉴定及药敏系统,用SPSS软件对数据进行分析。结果 2018~2019年共收集菌株1 179株,其中位于前3位的是大肠埃希菌420株(35.6%)、屎肠球菌167株(14.2%)、肺炎克雷伯菌126株(10.7%)。1 603株来自2020~2021年,大肠埃希菌(479株,29.9%)、肺炎克雷伯菌(282株,17.6%)和屎肠球菌(161株,10.0%)位于前3位。与2018~2019年相比,2020~2021年肺炎克雷伯菌的耐药率趋于稳定或有明显下降,但对第二代头孢菌素和氟喹诺酮类持续呈现较高的耐药率(>50%)。大肠埃希菌对大多数抗菌药物的耐药率呈明显下降趋势,但对环丙沙星和美罗培南的耐药率分别从73.8%、2.6%上升至76.6%、9.2%。屎肠球菌对喹诺酮类的耐药率持续高于95%,利奈唑胺耐药屎肠球菌检出率从1.8%显著增加至24.8%。结论 4年间该院尿路感染细菌谱和耐药性发生了变迁,应结合该院细菌耐药监测结果,合理使用抗菌药物。

Objective To understand the distribution and drug resistance of pathogens in urine culture in a hospital in the past 4 years, and to provide reference for the empirical treatment of urinary tract infection.Methods 2 782 positive specimens of clean middle urinary culture from inpatients in a hospital from January 2018 to December 2021 were analyzed retrospectively.The data were analyzed by Vitek 2 Compact automatic microbial identification and drug sensitivity system and SPSS software.Results 1 179 strains came from 2018-2019, among which E.coli(420 strains, 35.6%), E.faecium(167 strains, 14.2%) and K.pneumoniae(126 strains, 10.7%) were in the top 3. 1 603 strains came from 2020 to 2021, among which E.coli(479 strains, 29.9%), K.pneumoniae(282 strains, 17.6%) and E.faecium(161 strains, 10.0%) were in the top 3. Compared with 2018-2019, the resistance rate of K.pneumoniae to all tested drugs tended to be stable or decreased significantly from 2020 to 2021,but the resistance rate to the second-generation cephalosporins and fluoroquinolones continued to be high(>50%). The resistance rate of E.coli to most antibiotics showed a significant downward trend, but the resistance rate to ciprofloxacin and meropenem increased from 73.8% and 2.6% in 2018-2019 to 76.6% and 9.2% in 2020-2021, respectively.The resistance rate of E.faecium to quinolones continued to be higher than 95%, and the detection rate of linezolid resistant E.faecium increased significantly from 1.8% in 2018-2019 to 24.8% in 2020-2021. Conclusion The bacterial spectrum and drug resistance of urinary tract infection in our hospital were changed in the past 4 years. Antibiotics should be used reasonably in combination with the monitoring results of bacterial drug resistance in our hospital.