2018~2020年山东省两家三甲医院革兰阴性杆菌的分布及耐药情况分析

Distribution and Antimicrobial Resistance of Gram-Negative Bacilli of Two Hospitals in Shandong Province from 2018 to 2020

目的:分析2018~2020年山东省青岛大学附属医院(以下简称青大附院)和山东第一医科大学附属省立医院(以下简称省立医院)革兰阴性杆菌的检出情况及耐药性。方法:采用了抗菌药物耐药性趋势监测(SMART)项目中由青大附院和省立医院提供的菌株,由SMART中心实验室鉴定菌种。使用定制药敏板通过Trek系统进行抗菌药物敏感性测试并依据2022年第32版《抗微生物药物敏感性试验执行标准》进行药敏判读。比较两家医院革兰阴性杆菌的总检出率、加强监护病房(ICU)和非ICU病区的革兰阴性杆菌的检出率以及对常用抗菌药物的耐药率。结果:两家医院共检出非重复革兰阴性杆菌1727株,其中大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌的检出率分别为35.38%、20.09%、15.87%和11.41%。两家医院的ICU和非ICU病区中革兰阴性杆菌检出率显示出显著差异,表现为ICU病区大肠埃希菌的检出率低于非ICU病区,而肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌的检出率则高于非ICU病区的检出率(P<0.05)。两家医院检出的大肠埃希菌菌株均显示出对碳青霉烯类抗菌药物以及阿米卡星和黏菌素的极低耐药率。省立医院ICU病区检出的肺炎克雷伯菌对除黏菌素外的所有抗菌药物均显示出较高的耐药率,远超过青大附院,且耐药率比同一医院的非ICU病区来源的肺炎克雷伯菌耐药率相比均显著增加。省立医院ICU病区检出的铜绿假单胞菌对美罗培南、阿米卡星、黏菌素、左氧氟沙星、哌拉西林-他唑巴坦等的耐药率也均高于青大附院。但两家医院ICU和非ICU病区检出的鲍曼不动杆菌均仅对黏菌素显示耐药。结论:青大附院和省立医院虽同位于山东省,但在医院之间、同院的ICU和非ICU病区之间,主要革兰阴性杆菌对抗菌药物的耐药率仍存在差异,该结果表明有必要对院内的革兰阴性杆菌流行病学和细菌耐药情况进行实时监测,以便提供准确的抗菌药物的应用证据,以降低耐药菌传播风险。

Objective:To investigate the prevalence and drug resistance of Gram-negative bacilli(GNB)in the Affiliated Hospital of Medical College Qingdao University(QDUH)and Shandong Provincial Hospital Affiliated to Shandong First Medical University(SPH)from 2018 to 2020.Methods:All strains were obtained from the QDUH and SPH as part of the Surveillance of Multicenter Antimicrobial Resistance(SMART)project in China and identified and tested at the SMART Center Laboratory.Strains were tested for antimicrobial susceptibility using the Trek Diagnostic System withpersonalized antimicrobial panels,andthe minimum inhibitory concentration values were interpreted according to the Performance Standards for Antimicrobial Susceptibility Testing(Version 32),published in 2022.The study compared theoverall detection rates of GNB,the detection rates of GNB in Intensive Care Units(ICU)and non-ICU wards,and the resistance rates to conventional antimicrobial drugs between the two hospitals.Results:A total of 1,727 non-repetitive GNB were collected from the two hospitals.Escherichia coli(E.coli),Klebsiella pneumoniae(K.pneumoniae),Pseudomonas aeruginosa(P.aeruginosa)and Acinetobacter baumannii(A.baumannii)accounted for 35.38%,20.09%,15.87%and 11.41%of total strains,respectively.There were significant differences in the detection rate of GNB between the ICU and non-ICU wards in both hospitals.The ICU had a lower detection rate of E.coli,but significantly higher detection rates of K.pneumoniae,P.aeruginosa,and A.baumannii compared to the non-ICU(P<0.05).In term of drug resistance,E.coli in the ICUs of both hospitals exhibited very low resistance rates to carbapenems,amikacin and colistin.However,in the ICU of the SPH,the drug resistance rates of K.pneumoniae to all antimicrobial agents,except colistin,were significantly higher than those in the QDUH.The resistance rates were approximately 1-4 times higher in the ICU compared to the non-ICU of the same hospital,and approximately twice as high compared to the QDUH.Additionally,P.aeruginosa in the ICU of the SPH showed higher drug resistance rates to common antimicrobial agents(meropenem,amikacin,colistin,levofloxacin,piperacillin-tazobactam,etc)compared to the QDUH.Colistin was the only effective drug against A.baumannii in both ICUs and non-ICUs of the two hospitals.Conclusion:Differences in the resistance rates of major GNB to antimicrobial agents between ICU and non-ICU wards in QDUH and SPH were observed,despite both being located in Shandong Province.These findings highlight the importance of clinical surveillance of GNB epidemiology and bacterial resistance in our hospital,whichisessentialfor providing reliable evidence of antimicrobial agents use to reduce the risk of resistant bacterial transmission.