某院连续5年凝固酶阴性葡萄球菌的临床分布及耐药性变迁

Clinical Distribution and Drug Resistance Change of Coagulase-negative Staphylococcus in a Hospital for 5 Consecutive Years

目的分析2018—2022年鄂尔多斯市中心医院凝固酶阴性葡萄球菌(CNS)及耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的临床分布特点及抗菌药物耐药性的变化和趋势,为临床合理使用抗菌药物提供依据。方法回顾性分析2018年1月至2022年12月鄂尔多斯市中心医院门诊及住院患者分离的CNS和MRCNS标本来源、临床感染科室分布及耐药性变迁。结果临床标本中分离出菌株14027株,其中CNS 877株,占6.25%;CNS菌株亚型主要为表皮葡萄球菌(55.53%)、人葡萄球菌(16.65%)、溶血葡萄球菌(14.37%)等;CNS主要分离自分泌物(23.72%)、血液(21.21%)、引流液(17.79%)、尿液(17.10%)等;在神经外科检出率最高(16.88%),其次为骨科(14.71%)、儿科(13.68%)等;CNS对青霉素G的耐药率最高,5年均超过87.00%,对红霉素、苯唑西林、头孢西丁、左旋氧氟沙星等抗生素保持较高耐药率(51%~80%),对克林霉素、莫西沙星、庆大霉素、利福平等抗生素的耐药率较低(7%~45%),5年间均未发现对万古霉素、利奈唑胺、替加环素、替考拉宁耐药菌株;CNS中检出MRCNS 599株,占68.30%,2018—2020年MRCNS菌株检出率呈下降趋势,但在2020年检出率发生一次明显转折,2020—2022年检出率呈上升趋势,连续5年来MRCNS分离株均未发现对万古霉素、利奈唑胺、替加环素、替考拉宁耐药菌株,对红霉素、复方新诺明、克林霉素、利福平等抗生素的耐药率有下降趋势,对左旋氧氟沙星、莫西沙星、庆大霉素等抗生素的耐药率有上升趋势。结论通过对CNS在临床各科室中感染分布及耐药性变迁分析发现,CNS对多种抗菌药物的耐药情况严重,特别是MRCNS的耐药情况更加严重,应当引起临床科室重视,以后要更加合理、规范地应用抗菌药物,避免耐药菌株的产生,同时为临床感染防控提供科学的参考依据。

Objective:To analyze the clinical distribution characteristics and the change and trend of coagulase-negative Staphylococcus(CNS)and methicillin-coagulase-resistant Staphylococcus(MRCNS)of antimicrobial resistance in Ordos Central Hospital from 2018 to 2022,and to provide a basis for the rational use of antibiotics in clinical practice.Methods A retrospective analysis of CNS and MRCNS specimens,distribution of clinical infection departments and resistance changes from January 2018 to December 2022.Results A total of 14027 strains were isolated from clinical specimens from January 2018 to December 2022,Among which,the CNS 877 strain,Of the population was 6.25%,The main subtypes of CNS strains were Staphylococcus epidermidis(55.53%),Staphylococcus hominis(16.65%),Staphylococcus haemolyticus(14.37%),etc.CNS mainly isolated spontaneous secretions(23.72%),blood(21.21%),drainage fluid(17.79%),urine(17.10%),etc.The highest detection rate in neurosurgery(16.88%),Followed by orthopedics(14.71%),pediatrics(13.68%);CNS showed the highest resistance to penicillin G,Over 87.00%in all five years,Maintaining high resistance rates to antibiotics such as erythromycin,oxacillin,cefoxitin,and levofloxacin,Between 51%and 80%,Low resistance rates to antibiotics such as clindamycin,moxifloxacin,gentamicin,and rifampicin,Between 7%and 45%,No strains of vancomycin resistant to vancomycin,linezolid,tigecycline,and teicoplanin were found in five years;The MRCNS 599 strain was detected in the CNS,Accounted for 68.30%,The detection rate of MRCNS strains decreased from 2018 to 2020,But in 2020,a marked turn in the detection rate,Increasing detection rate from 2020-2022,No MRCNS isolates showed vancomycin,linezolid,tigecycline,and teicoplanin resistance,There was a trend towards decreasing resistance rates to erythromycin,cotrimoxazole,clindamycin,rifampin,and other antibiotics,The resistance rate to levofloxacin,moxifloxacin and gentamicin was increasing.Conclusion Through the coagulase negative Staphylococcus infection in clinical departments distribution and resistance changes,coagulase negative Staphylococcus for a variety of antimicrobial resistance is serious,especially MRCNS drug resistance is more serious,should cause clinical department,to be more reasonable,standardized application of antibiotics,avoid the production of drug-resistant strains,and provide scientific reference for clinical infection prevention and control.