河南省医疗机构2021年尿液标本细菌分布及其耐药性分析

Bacterial distribution and drug resistance of urine specimen from medical institutions in Henan Province in 2021

目的:统计分析2021年河南省临床微生物专科联盟241家医疗机构的尿液标本细菌分布及耐药状况,为合理应用抗菌药物及经验性治疗提供依据。方法:收集2021年河南省241家医疗机构收集的尿液标本,并从分离出的病原菌中筛选出非重复病原菌,依据美国实验室与临床标准化协会(CLSI)2019版标准判断药物敏感性,应用WHONET 5.6软件进行数据分析。结果:所有尿液标本中共分离获得26288株病原菌,其中三级医院检出19266株(73.3%),明显高于二级医院检出的7022株(26.7%);女性患者尿液标本中检出病原菌16202株(61.6%),高于男性尿液标本中检出的10086株(38.4%)。检出病原菌排名前5位的依次为大肠埃希菌(52.2%,13730/26288)、肺炎克雷伯菌(11.5%,3028/26288)、屎肠球菌(8.5%,2235/26288)、粪肠球菌(4.9%,1286/26288)、奇异变形杆菌(4.2%,1105/26288)。大肠埃希菌的碳青酶烯类耐药率在二级和三级医院分别为1.2%、1.5%,处于低水平;大肠埃希菌对喹诺酮类的耐药率高达60.0%以上。肺炎克雷伯菌的碳青酶烯类耐药率在二级和三级医院分别为16.3%和23.3%。在二级和三级医院中屎肠球菌的整体耐药率高于粪肠球菌,肠球菌对万古霉素、替考拉宁的耐药率均<1.0%,对利奈唑胺的耐药率<3.2%,铜绿假单胞菌对亚胺培南、美罗培南耐药率在二级和三级医院分别为7.4%、10.7%和6.1%、9.4%。分离自二级医院的病原菌的耐药率大多高于三级医院。结论:河南省医疗机构尿路感染的病原菌分布及耐药性与全国有差异,主要以大肠埃希菌、肺炎克雷伯菌和肠球菌为主,应重视区域细菌耐药监测,根据药敏结果合理选择抗菌药物,减少耐药株的产生。

Objective To count and analyze the bacterial distribution and the drug resistance of urine samples from 241 medical institutions of Henan Clinical Microbiology Alliance in 2021,so as to provide a basis for rational use of antibiotics and empirical treatment.Methods The urine samples were collected from 241 qualified medical institutions in Henan Province in 2021,and non-repeated pathogens were screened from the isolated pathogens.Drug sensitivity was determined according to Clinical and Laboratory Standards Institute(CLSI)2019 edition standard,and data analysis was performed by using WHONET 5.6 software.ResultssA total of 26288 strains of pathogenic bacteria were isolated from urine samples,including 19266 strains(73.3%)detected in samples from tertiary hospitals,which were significantly higher than 7022 strains(26.7%)detected in samples from secondary hospitals.A total of 16202 strains(61.6%)of pathogenic bacteria were detected in urine samples from female patients,higher than 10086 strains(38.4%)detected in urine samples from males.The top five pathogens were Escherichia coli(52.2%,13730/26288),Klebsiella pneumoniae(11.5%,3028/26288),Enterococcus faecium(8.5%,2235/26288),Enterococcus faecalis(4.9%,1286/26288),Proteus singular(4.2%,1105/26288),in sequence.The drug resistance rate of Escherichia coli to carbapenes in secondary and tertiary hospitals were 1.2%and 1.5%,respectively,which were at a low level.The drug resistance rate of Escherichia coli to quinolones was more than 60.0%.Resistance rate of Klebsiella pneumoniae to carbapenase in secondary and tertiary hospitals were 16.3%and 23.3%,respectively.In secondary and tertiary hospitals,the drug resistance rate of Enterococcus faecium was significantly higher than that of Enterococcus faecalis;the drug resistance rate of Enterococcus to vancomycin and teicoranin were less than 1.0%,and the drug resistance rate to linezolid was less than 3.2%.The resistance rate of Pseudomonas aeruginosa to imipenem and meropenem were 7.4%,10.7%in secondary hospitals,and 6.1%,9.4%in tertiary hospitals.The most of pathogens isolated from secondary hospitals had higher resistance rate to antibiotics than pathogens isolated from tertiary hospitals.Conclusions The distribution and drug resistance of pathogenic bacteria of urinary tract infection in medical institutions of Henan Province are different from that of the whole country,mainly including Escherichia coli,Klebsiella pneumoniae and Enterococcus.Attention should be paid to regional bacterial drug resistance monitoring,antibiotics should be selected reasonably according to drug sensitivity results,to reduce the generation of drug-resistant strains.