2017—2022年山东地区不同人群脓液标本病原谱及耐药性变迁分析

Composition of pathogen spectrum and drug susceptibility analysis of pus infections in different populations in Shandong Province from 2017 to 2022

目的监测山东地区2017—2022年不同年龄段患者脓液标本病原谱的构成和耐药性及药物敏感性情况,为外科医生早期经验性抗微生物治疗提供参考依据。方法回顾分析山东地区2017—2022年间山东省儿童细菌耐药监测研究协作网(Shandong Province Pediatric Antimicrobial Resistance Surveillance System,SPARSS)成员单位上报的脓液标本分离菌株的临床信息及药物敏感性结果。结果共分离病原菌64302株,新生儿脓液分离的细菌以革兰阳性菌为主,儿童和成人脓液分离的细菌以革兰阴性菌为主。对年龄分层分布发现,新生儿组病原菌分离最多的是金黄色葡萄球菌,儿童组和成人组脓液病原菌分离最多的是大肠埃希菌,3组的菌种分布有较大差异(χ2=245.5,P<0.0001)。肠杆菌科中大肠埃希菌和肺炎克雷伯菌耐药率较严重,产超广谱β-内酰胺酶(extended spectrumβ-lactamases,ESBLs)和对碳青霉烯类耐药的大肠埃希菌占比分别为41.8%和0.83%;肺炎克雷伯菌占比分别为14.1%和1.14%。铜绿假单胞菌对大多数抗生素成人组耐药率明显高于儿童组。葡萄球菌属中耐甲氧西林金黄色葡萄球菌(MRSA)检出率为22.6%且在2017—2022年呈下降趋势,其中新生儿MRSA占比显著高于儿童和成人(χ2=12.32,P=0.0021)。结论脓液感染病原菌以大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌和铜绿假单胞菌为主,不同年龄组的病原谱构成有较大差异,主要分离菌种对抗微生物药物的耐药率较高,故应定期监测脓液来源病原谱及耐药性变迁规律,以提高外科医生感染性疾病的精准诊治能力。

Objective To study the composition of pathogenic spectrum and drug resistance and susceptibility of pus samples from the patients of different ages in the Shandong area to provided a reference for early clinical empirical antimicrobial treatment for surgeons.Methods Clinical information and drug sensitivity results of isolates from pus samples reported by Shandong Province Pediatric Antimicrobial Resistance Surveillance System(SPARSS)members were retrospectively analyzed from 2017 to 2022.Results A total of 64302 strains of pathogenic bacteria were isolated.The bacteria isolated from neonatal pus were mainly Gram-positive bacteria,and the bacteria isolated from children's and adults'pus were mainly Gram-negative bacteria.In terms of age stratified distribution,Staphylococcus aureus was the most common pathogen isolated from the neonatal group,and Escherichia coli was the most common pathogen isolated from the pus of the children and adult group.The distribution of the bacteria was significantly different among the three groups(χ2=245.5,P<0.0001).The drug resistance rates of E.coli and Klebsiella pneumoniae were more serious in Enterobacteriaceae;the extended spectrumβ-lactamases(ESBLs)and carbapenem-resistant E.coli accounted for 41.8%and 0.83%,respectively;K.pneumoniae accounted for 14.1%and 1.14%,respectively.The resistance rate of Pseudomonas aeruginosa to most antibiotics in adults was significantly higher than that in children.The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)in Staphylococcus Spp.was 22.6%and decreased from 2017 to 2022,and the proportion of MRSA in newborns was significantly higher than that in children and adults(χ2=12.32,P=0.0021).Conclusion The main pathogens of pus infection were E.coli,S.aureus,K.pneumoniae and P.aeruginosa,and the pathogen spectrum composition of different age groups was quite different,and the resistance rate of the main isolates was relatively high.Therefore,it is necessary to regularly monitor the pathogen spectrum of pus sources and the change rule of drug resistance in order to improve the accurate diagnosis and treatment of infectious diseases by surgeons.