某三甲医院2017-2022年常见G^(-)菌的分布及耐药性分析

Distribution and drug resistance analysis of common G-bacteria in a three-A hospital from 2017 to 2022

目的 分析2017-2019年和2020-2022年我院革兰阴性(G^(-))菌的病原菌分布、细菌耐药情况,为临床合理地应用抗菌药物提供参考依据。方法 采用回顾性分析2017-2019年和2020-2022年我院的各类送检标本,采用专业认可的鉴定系统或手工方法进行细菌鉴定和耐药性检测,应用Whonet5.6软件进行数据分析。结果 共检出革兰阴性菌14421株,痰液标本最常见。2017-2019年我院分离的G^(-)菌居前5位者为大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、阴沟肠杆菌。2020-2022年我院分离的G^(-)菌居前5位者为肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、阴沟肠杆菌。两组主要标本来源均为痰、尿液和分泌物。2020-2022年和2017-2019年相比,大肠埃希菌和肺炎克雷伯菌对多数抗生素的耐药率呈下降趋势(P<0.05);肺炎克雷伯菌对环丙沙星的耐药率呈上升趋势(χ^(2)=6.045,P<0.05);2020-2022年和2017-2019年相比,鲍曼不动杆菌对左氧氟沙星耐药率呈上升趋势(χ^(2)=18.328,P<0.05),对氨基糖苷类庆大霉素和妥布霉素耐药率呈下降趋势(χ^(2)=46.647,χ^(2)=31.780,P均<0.05);铜绿假单胞菌对头孢他啶、喹诺酮类环丙沙星和左氧氟沙星耐药率呈上升趋势(χ^(2)=8.201,χ^(2)=4.298,χ^(2)=15.032,P均<0.05),对β-内酰胺类亚胺培南和美罗培南耐药率呈下降趋势(χ^(2)=26.089,χ^(2)=24.966,P均<0.05);阴沟肠杆菌对头孢呋辛钠耐药率呈下降趋势(χ^(2)=121.541,P<0.05)。结论 2020-2022年和2017-2019年相比,我院部分G^(-)菌对一些抗菌药物的耐药率有所下降,但总体G^(-)菌的耐药形势仍然十分严峻,需定期进行细菌耐药性监测。

Objective To analyze the distribution of pathogens and bacterial resistance of gram-negative(G-)bacteria in our hospital(2017-2019)and(2020-2022),so as to provide a reference for the rational clinical application of antibacterial drugs in the post-epidemic era.Methods Various specimens sent for examination in our hospital(2017-2019)and(2020-2022)were retrospectively analyzed,and the identification system or manual method was used to identify bacteria and detect drug resistance,and Whonet5.6 software was used for data analysis.Results A total of 14421 strains of gram-negative bacteria were detected,and sputum samples were the most common.The top 5 G-bacteria isolated in our hospital from 2017 to 2019 were Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii,pseudomonas aeruginosa,and Enterobacter cloacae.The top 5 G-bacteria isolated in our hospital from 2020 to 2022 were Klebsiella pneumoniae,Escherichia coli,Acinetobacter baumannii,pseudomonas aeruginosa and Enterobacter cloacae.The main sources of specimens in both groups were sputum,urine,and secretions.Compared with 2017-2019,the resistance rates of Escherichia coli and Klebsiella pneumoniae to most antibiotics showed a decreasing trend(P<0.05);The resistance rate of Klebsiella pneumoniae to ciprofloxacin was increased(χ^(2)=6.045,P<0.05).Compared with 2017-2019,the resistance rate of Acinetobacter baumannii to leofloxacin increased(χ^(2)=18.328,P<0.05),while the resistance rate of aminoglycosides gentamicin and tobramycin decreased(χ^(2)=46.647,χ^(2)=31.78,P<0.05).The resistance rates of Pseudomonas aeruginosa to ceftazidime,quinolone ciprofloxacin and levofloxacin were increased(χ^(2)=8.201,χ^(2)=4.298,χ^(2)=15.032,P<0.05),while the resistance rates ofβ-lactam imipename and lopenem were decreased(χ^(2)=26.0891,χ^(2)=24.966,P<0.05).The resistance rate of Enterobacter cloacae to cefuroxime sodium was decreased(χ^(2)=121.541,P<0.05).Conclusion Compared with 2017-2019,the resistance rate of some G-bacteria to some antibacterial drugs in our hospital has decreased from 2020 to 2022,but the overall resistance situation of G-bacteria is still very serious,and regular monitoring of bacterial resistance is required.