2017-2020年长沙市某医院结核病房病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria in tuberculosis wards in a hospital of Changsha from 2017 to 2020

目的回顾性分析2017—2020年长沙市中心医院结核病房病原菌分布及耐药性,为治疗结核患者合并其他病原菌感染提供科学依据。方法采用WHONET 5.6软件统计分析长沙市中心医院结核病房2017—2020年病原菌种类及数量、菌株样本来源及耐药率,采用SPSS 21.0软件比较分析结核普通病房与结核重症病房各病原菌的耐药性差异。结果2017—2020年长沙市中心医院结核病房患者感染的主要病原菌为革兰阴性杆菌(77.59%),检出病原菌主要来源于呼吸道样本。药敏结果显示,常见革兰阴性杆菌在2017—2019年对临床常用抗菌药物的耐药率有上升趋势,但是在2020年有轻微的回落;常见革兰阳性球菌对常用抗菌药物的耐药率趋于稳定;真菌中白色念珠菌和光滑念珠菌对各种抗真菌药物的耐药率趋于稳定,但热带念珠菌对伊曲康唑、伏立康唑、氟康唑有轻微的上升趋势。结核普通病房分离出的常见革兰阴性杆菌对大部分常用抗菌药物的耐药率低于结核重症病房,差异均有统计学意义(P<0.05);而溶血葡萄球菌对庆大霉素的耐药率低于重症病房菌株(χ^(2)=10.385,P=0.001),对四环素的耐药率高于重症病房菌株(χ^(2)=4.313,P=0.038);金黄色葡萄球菌对环丙沙星、利福平、莫西沙星、左氧氟沙星的耐药率低于重症病房菌株(χ^(2)=6.376、4.321、8.131、8.131,均P<0.05);肠球菌对常用抗菌药物的耐药率与重症病房菌株比较差异无统计学意义(均P>0.05)。结论长沙市中心医院结核病房不同样本来源的病原菌分布不同,以革兰阴性杆菌为主。四年间检出各病原菌耐药性总体上趋于稳定,结核重症病房菌株耐药形势严峻,应加强耐药性监测,根据药敏结果合理使用抗菌药物。

Objective To analyze retrospectively the distribution and drug resistance of pathogenic bacteria in tuberculosis wards in a hospital during the period from 2017 to 2020,so as to provide scientific basis for the treatment of tuberculosis patients with other pathogenic bacteria infections.Methods WHONET5.6software was used to statistically analyze the species and quantity of pathogenic bacteria,the source and drug resistance rate of strains detected in samples from the tuberculosis wards in Changsha Central Hospital from 2017 to 2020,and SPSS 21.O software was used to compare the difference in drug resistance between general tuberculosis ward and tuberculosis intensive care unit.Results In the period of 2017-2020 years,the main pathogens detected in the tuberculosis wards in the study hospital were gram-negative bailli(77.59%),and mainly from specimens collected from the respiratory tract.The drug sensitivity results showed that the rate of common gram-negative bacilli showing resistance to commonly used clinical antibiotics increased from 2017 to 2019,but decreased slightly in 2020;the resistance rate of common gram-positive cocci to common antibiotics remained stable;the resistance rates of Candida albicans and C.glabrata to various antifungal drugs tended to be stable,but the resistance rates of C.tropicalis to itraconazole,voriconazole and fluconazole increased slightly.The drug resistance rates of common gram-negative bacilli isolated from specimens collected in tuberculosis general ward to most commonly used antibiotics were lower than the drug resistance rates in tuberculosis intensive care unit,and the differences were all statistically significant(P<0.05).The rate of resistance to gentamicin was lower in Staphylococcus haemolyticus detected in general tuberculosis ward than that of strains in tuberculosis intensive care unit(χ^(2)=10.385,P=0.001),and the resistance rate to tetracycline was higher than in tuberculosis intensive care unit(χ^(2)=4.313,P=0.038),both with statistically significant differences.The resistance rates of S.aureus to ciprofloxacin,rifampicin,moxifloxacin and levofloxacin were lower in the general tuberculosis ward than in tuberculosis intensive care unit(χ^(2)=6.376,4.321,8.131,8.131,all P<0.05).The drug resistance rates of Enterococcus to common antibiotics showed no statistically significant difference between the general ward and intensive care unit(all P>0.05).ConclusionsSThe distribution of pathogens in specimens from different sources in tuberculosis wards in Changsha Central Hospital is different,with gram-negative bacilli being the main pathogens.In the past four years,the drug resistance of the pathogens detected was generally stable,and the drug resistance situation in tuberculosis intensive care unit is severe.Drug resistance monitoring should be strengthened,and antibiotics should be used appropriately according to the drug sensitivity results.