2013—2023年临沂地区伯克霍尔德菌的临床分布、感染特征及耐药分析

Clinical distribution,infection characteristics and drug resistance analysis of Burkholderia in Linyi area from 2013 to 2023

目的分析2013—2023年临沂地区检出伯克霍尔德菌的临床分布、感染特征和耐药情况,为该菌的抗感染治疗提供参考。方法回顾性分析2013—2023年临沂地区3家三甲医院分离鉴定的伯克霍尔德菌及其患者数据。结果共检出414株伯克霍尔德菌,洋葱伯克霍尔德菌373株(90.10%);主要分离自重症监护室(ICU)和呼吸内科,在痰标本中的占比最高(75.12%,311/414)。伯克霍尔德菌引起的感染与患者年龄、基础疾病情况、接受有创操作和广谱抗菌药物的使用情况相关;伯克霍尔德菌感染患者以60岁以上老年人为主(53.67%,212/395);其他伯克霍尔德菌感染患者合并2型糖尿病的比例高于洋葱伯克霍尔德菌感染患者,差异有统计学意义(χ^(2)=11.120,P=0.001)。洋葱伯克霍尔德菌对复方磺胺甲恶唑、头孢他啶、左氧氟沙星和米诺环素的耐药变化虽各不相同,但均低水平耐药;对美罗培南的耐药率近3年呈上升趋势;对替卡西林/克拉维酸的耐药率高。不同的伯克霍尔德菌对头孢他啶、替卡西林/克拉维酸和美罗培南耐药性差异大。结论2013—2023年临沂地区检出的伯克霍尔德菌主要来自ICU,以痰标本为主,易感人群是60岁以上老人;2型糖尿病是其他伯克霍尔德菌感染的危险因素;伯克霍尔德菌对常用抗菌药物的耐药率变化不一,临床医生可根据药敏结果优先选用耐药率低的抗菌药物。

Objective This study analyzed the clinical distribution,infection characteristics,and drug resistance of Burkholderia detected in the Linyi area from 2013 to 2023 and to provide references for anti-infective treatment of Burkholderia.Methods The data on Burkholderia isolated and identified from three hospitals in the Linyi area from 2013 to 2023 were analyzed retrospectively,along with the patient data.Results A total of 414 strains of Burkholderia were isolated,of which 373 were identified as Burkholderia cepacian,with an isolation rate of 90.10%.It was mainly isolated from the intensive care unit(ICU)and respiratory department and accounted for the highest proportion of sputum samples(311 strains,75.12%).The infection caused by Burkholderia was associated with patients'age,underlying diseases,invasive procedures,and use of broad-spectrum antibiotics.Most patients with the Burkholderia infection were over 60 years old(53.67%,212/395).The proportion of type 2 diabetes in patients with other Burkholderia infections was higher than that in patients with Burkholderia cepacia infections,and the difference was statistically significant(χ^(2)=11.120,P=0.001).The resistance rates of Burkholderia cepacia to trimethoprim-sulfamethoxazole,ceftazidime,levofloxacin,and minocycline remained unstable over the past decade,but the resistance rate was low.The resistance rate to meropenem showed an increasing trend in the past 3 years.The resistance rate of Burkholderia cepacia to ticacillin/clavulanic acid was high.Resistance to ceftazidime,ticacillin/clavulanate and meropenem varied significantly among different Burkholderella species.Conclusion The Burkholderia detected in the Linyi area during 2013—2023 mainly came from ICU,mainly sputum samples,and the most vulnerable population were people over the age of 60.Type 2 diabetes was one of the risk factors for other Burkholderia infections.The resistance rate of Burkholderia to antibiotics commonly used varied,and clinicians could preferentially select antibiotics with a low resistance rate according to the results of drug sensitivity.