2021年某院细菌培养阳性病原菌分布及耐药性分析

Distribution and Drug Resistance of Bacterial Culture-Positive Pathogens in a Hospital in 2021

目的为临床感染性疾病的诊治提供参考。方法采用质谱分析仪鉴定江苏省苏州市吴江区儿童医院和苏州大学附属儿童医院(以下称为该院)2021年1月至12月收治的年龄不超过16岁患儿的细菌培养标本,依据美国临床和实验室标准协会(CLSI)抗菌药物的药物敏感性试验执行标准判定检测结果,并分析细菌培养阳性病原菌的分布及耐药性。结果共收到送检标本37976份,主要来源于血液(49.19%)、痰液(19.83%)、粪便(14.81%)、中段尿液(13.00%);分离出可能致病菌3980株,标本来源阳性检出率排前3位的分别为脓性分泌物(80.57%)、耳朵分泌物(50.48%)、痰液(23.94%),其中革兰阳性菌1842株(46.28%)、革兰阴性菌2053株(51.58%)、真菌85株(2.14%)。革兰阳性菌中,排前3位的分别为肺炎链球菌(32.79%)、金黄色葡萄球菌(31.54%)、屎肠球菌(14.17%);革兰阴性菌中,排前3位的分别为沙门菌属(35.36%)、大肠埃希菌(15.20%)、流感嗜血杆菌(13.20%)。药物敏感性试验结果显示,沙门菌属对庆大霉素、阿米卡星、头孢唑林、氨苄西林、哌拉西林、哌拉西林他唑巴坦、亚胺培南、美罗培南的耐药率分别为100.00%,100.00%,100.00%,75.62%,75.62%,5.92%,4.41%,4.41%;大肠埃希菌对氨苄西林、美罗培南、亚胺培南、头孢哌酮舒巴坦的耐药率分别为85.58%,14.42%,14.10%,0;肺炎链球菌对头孢呋辛、头孢曲松、头孢哌酮舒巴坦、万古霉素、利奈唑胺的耐药率分别为48.01%,44.04%,3.31%,0,0;金黄色葡萄球菌对头孢西丁、氨苄西林、青霉素、利奈唑胺、万古霉素、替考拉宁、氯霉素的耐药率分别为100.00%,100.00%,89.85%,0,0,0,0。结论该院感染性疾病的送检标本以血培养为主,但阳性检出率以脓性分泌物最高;革兰阴性菌为主要致病菌,对β-内酰胺类抗菌药物较敏感;革兰阳性菌对万古霉素、利奈唑胺较敏感。临床用药时应根据药物敏感性试验结果进行个体化用药,以减少耐药的产生。

Objective To provide a reference for clinical diagnosis and treatment of infectious diseases.Methods A mass spectrometry analyzer was used to identify bacterial culture samples from children under 16 years old admitted to the Children's Hospital of Wujiang District and the Children's Hospital of Soochow University(hereinafter referred to as the hospital)from January to December 2021.The test results were determined based on the Performance Standards for Antimicrobial Susceptibility Testing in the American Clinical and Laboratory Standards Institute(CLSI),and the distribution and resistance of bacterial culture-positive pathogens were analyzed.Results A total of 37976 samples were received for examination,mainly from blood(49.19%),sputum(19.83%),feces(14.81%),and middle urine(13.00%).A total of 3980 potential pathogenic bacteria were isolated,and the top three positive detection rates of specimen sources were purulent secretion(80.57%),ear secretions(50.48%),and sputum(23.94%),including 1842 strains(46.28%)of Gram-positive bacteria,2053 strains(51.58%)of Gram-negative bacteria and 85 strains(2.14%)of fungi.Among Gram-positive bacteria,the top three were Streptococcus pneumoniae(32.79%),Staphylococcus aureus(31.54%),and Enterococcus faecalis(14.17%).Among Gram-negative bacteria,the top three were Salmonella(35.36%),Escherichia coli(15.20%),and Haemophilus influenzae(13.20%).The drug sensitivity test results showed that the resistance rates of Salmonella to gentamicin,amikacin,cefazolin,ampicillin,piperacillin,piperacillin-tazobactam,imipenem,and meropenem were 100.00%,100.00%,100.00%,75.62%,75.62%,5.92%,4.41%,and 4.41%,respectively;the resistance rates of Escherichia coli to ampicillin,meropenem,imipenem,and cefoperazone-sulbactam were 85.58%,14.42%,14.10%,and 0,respectively;the resistance rates of Streptococcus pneumoniae to cefuroxime,ceftriaxone,cefoperazone-sulbactam,vancomycin,and linezolid were 48.01%,44.04%,3.31%,0,and 0,respectively;the resistance rates of Staphylococcus aureus to cefoxitin,ampicillin,penicillin,linezolid,vancomycin,teicoplanin,and chloramphenicol were 100.00%,100.00%,89.85%,0,0,0,and 0,respectively.Conclusion The samples of infectious diseases in this hospital were mainly blood cultures,but the positive detection rate was the highest in purulent secretions.Gram-negative bacteria were the main pathogenic bacteria of children,which were more sensitive toβ-lactam antibacterial drugs.Gram-positive bacteria are more sensitive to vancomycin and linezolid.Individualized drug use should becarried out according to the results of drug sensitivity test in clinical practice to reduce the occurrence of drug resistance.