2015~2019年重庆某三甲医院革兰阴性杆菌的分布特点和耐药性变迁

Changes in Distribution Characteristics and Drug Resistance of Gram-Negative Bacilli in a Tertiary Hospital in Chongqing from 2015 to 2019

目的:对重庆某三甲医院2015~2019年期间临床分离的革兰阴性杆菌的分布和耐药性进行监测。方法:利用抗菌药物耐药性趋势监测(SMART)项目提交的重庆某医院革兰阴性杆菌标本,使用定制药敏板通过Trek系统进行抗菌药物敏感性测试。结果:共收集来自腹腔、呼吸道、尿路和血流感染患者的950株革兰阴性杆菌标本。其中大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌的检出率分别为43.37%、18.63%、14.11%、10.84%。鲍曼不动杆菌和铜绿假单胞菌对常规抗菌药物的耐药率较高但5年内变化较小。而肺炎克雷伯菌在2017年对第三代头孢菌素类和氟喹诺酮类药物的耐药率较2016年明显上升,对碳青霉烯类药物的耐药率在2019年降至20%以下。此外,不同感染部位的革兰阴性杆菌的耐药率也存在显著差异。其中,尿路感染来源的鲍曼不动杆菌对氟喹诺酮类抗菌药物左氧氟沙星和黏菌素均具有较高的敏感率;然而在腹腔和呼吸道感染中,其耐药率大多数超过50%。对于检出的耐碳青霉烯类鲍曼不动杆菌、对头孢噻肟或头孢曲松耐药的大肠埃希菌、耐氟喹诺酮类大肠埃希菌、多重耐药鲍曼不动杆菌和多重耐药铜绿假单胞菌,目前可选用的常规抗菌药物较少。结论:该院2015~2019年期间革兰阴性耐药菌的问题比较突出,尤其是三代头孢菌素耐药肠杆菌目细菌。而鲍曼不动杆菌无论是否为特殊耐药菌,对大部分抗菌药物的耐药率都很高,有待于持续监测并结合临床实际合理选择有效抗菌药物。

Objective:To monitor the distribution and drug resistance of Gram-negative isolates from a hospital in Chongqing from 2015 to 2019.Methods:Specimens containing Gram-negative bacilli from a hospital in Chongqing submitted by Study for Monitoring Antimicrobial Resistance Trends(SMART)were used to perform antimicrobial susceptibility testing employing the custom sensitivity plate and Trek system.Results:A total of 950 Gram-negative isolates from patients with abdominal,respiratory,urinary,and bloodstream infections were collected.Among which,the detected Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii accounted for 43.37%,18.63%,14.11%and 10.84%,respectively.The resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa to conventional antimicrobials were high but without obvious changes from 2015 to 2019.The resistance rates of Klebsiella pneumoniae to third-generation cephalosporins and fluoroquinolones in 2017 increased significantly as compared with that in 2016,while the figure for resistance to carbapenems decreased to lower than 20%in 2019.In addition,there was a significant difference in the resistance rates of Gram-negative bacilli across infection sites.Among them,it was noted that high sensitivity rate of Acinetobacter baumannii obtained from urinary tract infection to both levofloxacin and colistin.However,in terms of abdominal and respiratory tract infections,the drug resistance rates were more than 50%.Fewer conventional antimicrobials are currently available for detected carbapenem-resistant Acinetobacter baumannii,cefotaxime-or ceftriaxone-resistant Escherichia coli,fluoroquinolone-resistant Escherichia coli,multidrug-resistant Acinetobacter baumannii,and multidrug-resistant Pseudomonas aeruginosa.Conclusion:The problem regarding the drug resistance of Gram-negative bacteria in the hospital from 2015 to 2019 was relatively prominent,particularly the third-generation cephalosporin-resistant germs in Enterobacterales order.The resistance rates of Acinetobacter baumannii to most antimicrobials is very high regardless of whether it is a special drug-resistant bacteria,which needs continuously monitoring and reference to clinical practice for reasonable selection of effective antimicrobials.