2018—2021年某医院血培养病原菌分布及耐药性分析

Distribution and drug resistance analysis of pathogenic bacteria in a hospital blood culture,2018-2022

目的分析新冠疫情前后2年(2018—2019年以及2020—2021年)血流感染患者血培养标本病原菌分布及耐药性分析,为后疫情时期血流感染的合理治疗提供参考和疫情后期有效控制血流感染提供科学依据。方法收集武汉大学中南医院2018—2021年患者的血培养标本,采用全自动细菌和分枝杆菌培养系统和血培养仪,对临床送检的血液标本进行血培养,Vitek MS全自动快速微生物质谱进行菌株鉴定和Vitek 2全自动微生物鉴定及药敏分析系统进行药敏试验和耐药性分析。结果2018年1月—2019年12月送检的28736例疑似血流感染患者的血培养,剔除重复菌株后共检出2181株病原菌,阳性率为7.59%,检出革兰阴性菌1046株,检出率47.96%。2020年1月—2021年12月送检的26083例疑似血流感染患者的血培养,剔除重复菌株后共检出2111株病原菌,阳性率8.09%,革兰阴性菌1000株,检出率47.37%。肺炎克雷伯菌耐药情况较为严重,仅对厄他培南、多粘菌素B、替加环素的敏感率在90%以上,主要非发酵菌鲍曼不动杆菌对哌拉西林/他唑巴坦、阿米卡星、多粘菌素B的敏感率在50%以上。铜绿假单胞菌对哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、阿米卡星、庆大霉素、妥布霉素、环丙沙星、左氧氟沙星、哌拉西林、美洛培南的敏感率在50%以上。结论疫情前后两年血流感染病原菌分布种类较多,但分布差别不大。科室分布主要在ICU、肝胆研究院、肾病内科等。其中以大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌等革兰阴性菌为主,不同病原菌呈现出较大的耐药性差异。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in blood culture specimens of patients with bloodstream infections before and after COVID-19(2018-2019 and 2020-2021),and to provide scientific basis and reference for rational treatment and effective control of bloodstream infections in the post-epidemic period.Methods Blood culture specimens were collected from patients in Zhongnan Hospital of Wuhan University in the two years before and after the COVID-19 outbreak(2018-2021).The Automated Blood Culture Systems were used to perform blood culture on blood specimens sent for clinical inspection,and the Vitek MS automatic bacterial identification mass spectrometer was used for strain identification and the Vitek 2 automatic bacterial drug susceptibility analyzer was used for drug susceptibility testing and drug resistance analysis.Results Blood culture specimens were performed on 28736 patients with suspected bloodstream infection submitted for inspection from January 2018 to December 2019,and a total of 2181 strains of pathogenic bacteria were detected after removing duplicate strains,with a positive rate of 7.69%,including 1046 strains of Gram-negative bacteria,accounting for 47.96%.From January 2020 to December 2021,blood culture specimens from 26083 patients with suspected bloodstream infection were submitted for inspection,and a total of 2111 strains of pathogenic bacteria were detected after excluding duplicate strains,with a positive rate of 8.09%,including 1000 strains of Gram-negative bacteria accounted for 47.37%.The drug resistance of Klebsiella pneumoniae was relatively serious,and the sensitivity rate to ertapenem,polymyxin B and tigecycline was more than 90%.The main non-fermentative bacteria Acinetobacter baumannii was more than 50%sensitive to piperacillin/tazobactam,amikacin and polymyxin B.The sensitivity rates of Pseudomonas aeruginosa to piperacillin/tazobactam,ceftazidime,cefepime,amikacin,gentamicin,tobramycin,ciprofloxacin,levofloxacin,piperacillin and meropenem were more than 50%.Conclusions In the two years before and after COVID-19,there are many types of pathogenic bacteria in bloodstream infection,but the distribution do not differ significantly.The pathogens of bloodstream infection are mainly distributed in ICU,hepatobiliary research institute,and nephrology department.Among them,Gram-negative bacteria such as Escherichia coli,Klebsiella pneumoniae and Acinetobacter baumannii are the main ones,and different pathogens showed great differences in drug resistance.