2020—2022年甘肃地区血培养临床分离菌分布及耐药性

Distribution and antibiotic resistance of clinical isolates from blood culture in Gansu Province from 2020 to 2022

目的 了解甘肃地区血培养临床分离菌的构成、耐药性及在不同年龄人群中分布。方法 采用WHONET 5.6软件,依据CLSI M100 2022年标准判读分析2020年1月—2022年12月甘肃地区细菌耐药监测网数据合格成员单位血培养临床分离菌的分布及耐药性。结果 3年共检测出非重复分离菌12818株,其中革兰阳性菌占40.4%,革兰阴性菌占59.6%。儿童患者、成年患者和老年患者分离菌分别占总分离菌的14.2%、51.5%和34.3%。MRSA和MRCNS分别占金黄色葡萄球菌和CNS的35.5%和71.7%,儿童患者MRSA的检出率远低于成年患者和老年患者分离株,3组患者MRSA的检出率依次为22.2%、38.1%和38.3%,均未检出万古霉素、替考拉宁和利奈唑胺耐药菌株。除万古霉素、替考拉宁和利奈唑胺外,屎肠球菌对其他受试药物的耐药率均高于粪肠球菌。肺炎链球菌中未发现青霉素G耐药菌株,对万古霉素和利奈唑胺均敏感。大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌和黏质沙雷菌对碳青霉烯类耐药率分别为0.2%~0.4%、5.2%~6.0%、7.6%~8.1%和3.2%~11.0%,成年和老年患者大肠埃希菌分离株分别对近1/2受试药物和1/3受试药物的耐药率高于儿童分离株(P<0.05),而儿童患者肺炎克雷伯菌分离株对近2/3受试药物的耐药性高于成年和老年患者分离株(P<0.05)。铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类的耐药率分别为12.2%~15.1%和68.5%~68.8%。结论 2020—2022年甘肃地区血培养临床分离菌耐药情况严重,不同年龄人群常见分离菌的分布和耐药性存在差异,尤其儿童患者与成年及老年患者部分革兰阴性杆菌分离株的检出率和耐药性差异明显。

Objective To analyze the population distribution of bacteria from blood culture and the antibiotic resistance profile among children,adults and elderly patients in Gansu Province.Methods WHONET 5.6 software was used to investigate the distribution and antimicrobial susceptibility of bacteria isolated from blood cultures of qualified hospitals in the Gansu antimicrobial susceptibility surveillance system from January 2020 to December 2022,and the results were determined according to CLSI M1002022.Results A total of 12818 non-repeated isolates were collected from 2020 to 2022,of which Gram-positive bacteria and Gram-negative bacteria account for 40.4%and 59.6%,respectively.The isolates from children,adults and elderly patients accounted for 14.2%,51.5%and 34.3%.The prevalence of MRSA in S.aureus and MRCNS in coagulase-negative Staphylococcus was 35.5%and 71.7%,respectively.The percentage of MRSA in children was significantly lower than that in adults and elderly patients;they account for 22.2%,38.1%and 38.3%,respectively.Only vancomycin,teicoraline and linezolid-resistant strains were not detected in the CNS or S.aureus.The resistance of E.faecium to most of the tested antibiotics was higher than that of E.faecalis,apart from vancomycin,teicolanin and linezolid.No Streptococcus pneumonia strains were found resistant to penicillin G,vancomycin and linezolid.The resistance of Escherichia coli,Klebsiella pneumoniae,Serratia marcescens and Enterobacter to carbapenems ranged from 0.2%~0.4%,5.2%~6.0%,7.6%~8.1%and 3.2%~11.0%.The resistance of Escherichia coli in adults and elderly patients to 1/2 of tested antibiotics and 1/3 of tested antibiotics was higher than that in children,respectively.However,the resistance of Klebsiella pneumoniae in adults and elderly patients to 2/3 tested antibiotics was lower than that in children(P<0.05).The resistance of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenems ranged from 12.2%to 15.1%and from 68.5%to 68.8%,respectively.Conclusion From 2020 to 2022,the resistance of clinical isolates from blood culture in Gansu province was still severe,and there were differences in the detection rate and drug resistance of isolates in different age groups,especially Gram-negative bacteria,between children and non-child patients.