某医院2015—2020年尿路感染病原菌分布及耐药性变迁

Distribution of pathogenic bacteria of urinary tract infection and changes of drug resistance in a hospital from 2015 to 2020

目的了解郑州大学附属儿童医院2015年1月至2020年12月尿路感染病原菌的分布及耐药性变迁,监测耐药性变化,为临床合理用药提供依据。方法采用WHONET 5.6软件,分析6年间(2015年1月至2020年12月)郑州大学附属儿童医院尿路感染患儿分离获得的主要病原细菌分布及抗菌药物耐药变迁情况。结果剔除同一患者重复菌株后,1236例尿路感染患儿共检出1309株致病菌,其中革兰阴性菌687株(52.48%),革兰阳性菌562株(42.93%),真菌60株(4.58%)。主要革兰阴性菌是大肠埃希菌(352株,26.89%)和肺炎克雷伯菌(102株,7.79%);屎肠球菌(270株,20.63%)、粪肠球菌(215株,16.42%)是最多见的革兰阳性菌。6年间,大肠埃希菌检出比例明显降低,由31%下降至20.06%(χ^(2)=12.374,P=0.03);其它主要检出菌肺炎克雷伯菌、屎肠球菌、粪肠球菌检出比例维持稳定(均P>0.05),阴道加德纳菌近两年检出率明显升高(χ^(2)=18.107,P<0.001)。本研究中产超广谱β-内酰胺酶(extended Spectrum Beta-Lactamases,ESBLs)大肠埃希菌检出率在2015年至2020年间发生显著的下降(P<0.05),大肠埃希菌对头孢曲松、左旋氧氟沙星、呋喃妥因的耐药率均发生有统计学意义的变化(均P<0.05),其中头孢曲松2018年耐药率高达79.59%,而至2019年和2020年有下降趋势。对头孢吡肟和复方磺胺甲恶唑(复方新诺明)持续维持较高的耐药率(均P>0.05),2020年复方磺胺甲恶唑耐药率更高达82.26%;大肠埃希菌对阿米卡星、亚胺培南、呋喃妥因、头孢哌酮/舒巴坦耐药率较低,2020年对上述药物的耐药率分别为6.45%、11.29%、3.23%、14.25;且2015年至2020年间,肺炎克雷伯菌对常用抗菌药物的耐药率各时间段间差异无统计学意义(均P>0.05),肺炎克雷伯菌各年碳青霉烯耐药的肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)检出率普遍高于大肠埃希菌;2015年至2020年间粪肠球菌对高浓度庆大霉素耐药率均发生有统计学意义的变化(P<0.05),其中屎肠球菌2019年检出率最高56.60%,粪肠球菌2018年度最高达33.33%。未发现耐万古霉素和利奈唑胺的阳性菌。结论2015年至2020年间郑州大学附属儿童医院尿路感染以革兰阴性病原菌为主,大肠埃希菌和肺炎克雷伯革兰阴性菌是尿路感染的主要病原菌,其对三代头孢菌素耐药率以2017至2018年最高,2019至2020年耐药率呈现不同水平的下降,对阿米卡星、亚胺培南、呋喃妥因维持较高敏感性。屎肠球菌和粪肠球菌是尿路感染中最常见的阳性球菌,屎肠球菌对各组抗生素耐药率普遍高于粪肠球菌。尿路感染治疗过程中,应结合病原菌耐药情况及患者病情制订个体化的治疗方案,以遏制耐药菌的扩散和流行。

Objective To understand the distribution of urinary tract infection pathogens and the changes in drug resistance from January 2015 to December 2020 in the Children's Hospital of Zhengzhou University,monitor the changes in drug resistance,and provide a basis for clinical rational use of drugs.Methods The WHONET 5.6 software was used to analyze the distribution of the main pathogenic bacteria and the changes in antimicrobial resistance of children with urinary tract infections admited from January 2015 to December 2020.Results After excluding duplicate strains from the same patient,a total of 1,309 pathogenic bacteria were detected in 1,236 children with urinary tract infections,including 687(52.48%)Gram-negative bacteria,562 Gram-positive bacteria(42.93%),and 60 fungus(4.58%).The main gram-negative bacteria were Escherichia coli(352 strains,26.89%)and Klebsiella pneumoniae(102 strains,7.79%);Enterococcus faecium(270 strains,20.63%),Enterococcus faecalis(215 strains,16.42%)was the most common gram-positive bacteria.In 6 years,the detection rate of Escherichia coli decreased significantly,from 31%to 20.06%(χ^(2)=12.374,P=0.03);The rates of detection of other major detected bacteria(Klebsiella pneumoniae,Enterococcus faecium,and Enterococcus faecalis)remained stable(P>0.05),and the detection rate of Gardnerella vaginalis increased significantly in the past two years(χ^(2)=18.107,P<0.001).The detection rate of ESBLs-producing Escherichia coli in this study decreased significantly from 2015 to 2020(P<0.05),and the changes of resistance rates of Escherichia coli to ceftriaxone,levofloxacin,and nitro-furantoin were all statistically in academic significance(P<0.05),the resistance rate of ceftriaxone in 2018 was as high as 79.59%,and there was a downward trend in 2019 and 2020;To cefepime and compound sulfamethoxazole con-tinued to maintain a high resistance rate(P>0.001),the resistance rate of compound sulfamethoxazole in 2020 was as high as 82.26%;E.coli is relatively sensitive to amikacin,imipenem,nitrofurantoin,and Cefoperazone/Sulbactam.The resistance rates to these drugs in 2020 are 6.45%,11.29%,3.23%,and 14.25 respectively;From 2015 to 2020,the resistance rate of Klebsiella pneumoniae to commonly used antibacterial drugs was no statistically different(P>0.05),and the CRE detection rate of Klebsiella pneumoniae in each year was generally higher than that of Esche-richia coli.The resistance rate of Enterococcus faecalis to high concentrations of gentamicin changed statistically from 2015 to 2020(P<0.05).The detection rate of Enterococcus faecalis was the highest in 2019,56.60%,and Entero-coccus faecalis in 2018 was the highest 33.33%.No Gram-positive bacteria resistant to vancomycin and linezolid were found.Conclusion From 2015 to 2020,urinary tract infections in our hospital were dominated by gram-negative pathogens.Escherichia coli and Klebsiella pneumoniae were the main pathogens of urinary tract infections.The resist-ance rate to third-generation cephalosporins was 2017-2018 the highest,the drug resistance rate in 2019-2020 showed different levels of decline,maintaining high sensitivity to amikacin,imipenem,and nitrofurantoin.Enterococcus faecium and Enterococcus faecalis was the most common positive cocci in urinary tract infections.The resistance rate of Enterococcus faecium to each group of antibiotics was generally higher than that of Enterococcus faecalis.In the treat-ment of urinary tract infections,individualized treatment plans should be formulated based on the drug resistance of pathogens and the patient's condition to curb the spread and prevalence of resistant bacteria.