2017-2022年山东省人群眼部感染病原菌的构成及耐药性

Composition and drug resistance of pathogenic bacteria in human eye infection in Shandong Province between 2017 and 2022

目的分析山东省不同人群眼部分离病原菌的构成及耐药情况,为临床抗微生物药物选择提供参考依据。方法本研究为回顾性分析,收集山东省儿童微生物组学研究中心儿童细菌&真菌耐药监测研究协作网成员单位(52家三级医院,7家二级医院)于2017年1月至2022年12月上报的731株来自眼部感染患者的病原菌,来源部位包括结膜囊分泌物、睑缘分泌物、泪囊分泌物、角膜刮片及玻璃体穿刺,采用质谱系统、全自动微生物鉴定系统、API系统等对分离菌种进行鉴定,美国临床和实验室标准化协会推荐的药敏试验方法进行药敏试验及药敏结果判读,利用WHONET 5.6软件对数据进行整理分析,SPSS 21.0软件对细菌耐药性差异进行统计分析。结果①分离病原菌以革兰阳性菌为主(70.2%),其中葡萄球菌属居于首位,儿童以金黄色葡萄球菌感染为主,成年人和老年人以表皮葡萄球菌为主;革兰阴性菌以铜绿假单胞菌为主。真菌感染主要发生于成年男性,以镰刀菌属为主;②革兰阳性菌对万古霉素、利奈唑胺耐药率为0,利福平2.0%,氯霉素4.3%,庆大霉素9.2%,莫西沙星10.6%,左氧氟沙星33.2%,红霉素77.6%。葡萄球菌对青霉素G耐药率高于链球菌,表皮葡萄球菌对利福平、奎奴普丁/达福普汀、莫西沙星、四环素、环丙沙星、左氧氟沙星、复方新诺明耐药率高于金黄色葡萄球菌;缓症链球菌对左氧氟沙星耐药率高于肺炎链球菌;③革兰阴性菌对阿米卡星耐药率1.7%,妥布霉素8.0%,左氧氟沙星11.1%,庆大霉素11.2%,氯霉素18.2%,铜绿假单胞菌耐药率普遍偏低。结论①葡萄球菌是感染性眼病主要致病菌;②革兰阳性菌对红霉素、青霉素普遍耐药;革兰阴性菌耐药率控制良好。临床对于眼部革兰阳性菌感染,除了考虑万古霉素等终极药物外,也可使用利福平治疗;对于革兰阴性菌感染,可考虑使用阿米卡星治疗;③要重视并监测不同年龄段人群眼部病原菌种类的分布及变化趋势,根据药物敏感结果规范合理使用抗生素,并重新评价眼科临床已较少使用的抗生素价值。

Objective To explore the composition and drug resistance of ocular pathogens isolated from different populations in Shandong,and to provide reference for clinical antimicrobial drug selection.Methods In this retrospective analysis,731 strains of pathogenic bacteria were collected,which were from patients with eye infection reported by members of the Shandong Province Pediatric Antimicrobial Resistance Surveillance System(52 tertiary hospitals and 7 secondary hospitals)between Jan.2017 and Dec.2022.The source sites included conjunctival sac secretions,palpebral margin secretions,lacrimal sac secretions,corneal scrape and vitreous puncture.The isolated strains were identified with mass spectrum system,automatic microbial identification system and API system.The drug sensitivity test methods recommended by the American Association for Clinical and Laboratory Standards were performed and the results were interpreted.The data were analyzed with WHONET 5.6,and the differences in bacterial resistance were analyzed with SPSS 21.0.Results①The main pathogens isolated were gram-positive bacteria(70.2%),among which Staphylococcus ranked the first;Staphylococcus aureus was the main pathogen in children,and Staphylococcus epidermidis was the main pathogen in adults and the elderly.The gram-negative bacteria were mainly pseudomonas aeruginosa.Fungal infection occurred mainly in adult males,with Fusarium as the dominant species.②The resistance rates of gram-positive bacteria to vancomycin and linezolid were 0,rifampicin 2.0%,chloramphenicol 4.3%,gentamicin 9.2%,moxifloxacin 10.6%,levofloxacin 33.2%and erythromycin 77.6%.The resistance rate of Staphylococcus to penicillin G was higher than that of streptococcus.The resistance rates of Staphylococcus epidermidis to rifampicin,quinuptin/dafotene,moxifloxacin,tetracycline,ciprofloxacin,levofloxacin and cotrimoxazole were higher than those of Staphylococcus aureus.The resistance rate of Streptococcus bradycida to levofloxacin was higher than that of Streptococcus pneumoniae.③The resistance rate of gram-negative bacteria to amikacin was 1.7%,tobramycin 8.0%,levofloxacin 11.1%,gentamicin 11.2%and chloramphenicol 18.2%.The resistance rate of Pseudomonas aeruginosa was generally low.Conclusion①Staphylococcus is the main pathogen of infectious eye diseases.②Gram-positive bacteria were generally resistant to erythromycin and penicillin.The drug resistance rate of gram-negative bacteria can be well controlled.In addition to vancomycin and other ultimate drugs,rifampicin can be used to treat ocular gram-positive infection.Amilacin may be considered for gram-negative bacterial infections.③It is necessary to pay attention to and monitor the distribution and change trend of ocular pathogens in different age groups.The use of antibiotics should be standardized according to the results of drug sensitivity.The value of antibiotics that have been rarely used in ophthalmology should also be re-evaluated.