2017—2022年山东地区不同人群关节感染病原谱及耐药性变迁分析

Composition of the pathogen spectrum and drug susceptibility analysis of joint fluid infections in different populations in Shandong Province,from 2017 to 2022

目的了解山东地区不同人群、不同年份分离自关节液标本的病原谱构成和耐药性差异,为关节部位感染的临床早期经验性治疗提供参考依据。方法利用WHONET5.6分析软件,回顾分析山东地区2017—2022年间SPARSS网成员单位上报的1243株关节液标本病原菌构成及主要病原菌耐药性变迁规律。结果关节液中的主要分离菌为大肠埃希菌(42.1%)和金黄色葡萄球菌(19.1%);男女菌株构成比为59:41;不同年份菌株构成差异加大,2019年分离菌株360株,为历年最多。儿童组和中青年组关节液分离的细菌以革兰阴性菌为主,老年组关节液分离的细菌以革兰阳性菌为主。儿童组、中青年组与老年组的革兰阳性菌和革兰阴性菌的菌种分布有统计学差异(χ^(2)=42.84,P<0.0001)。肠杆菌科中产ESBLs的大肠埃希菌占比为49.8%,耐碳青霉烯类大肠埃希菌占比1.0%。耐甲氧西林金黄色葡萄球菌的比率为29.8%。结论山东地区不同人群、不同年份关节液病原菌菌种分布不同,且不同病原菌对各种抗菌药物耐药性存在较大差异,因此对不同人群进行病原菌的分布和耐药性监测,对提高关节部位感染的诊治水平和指导临床合理用药十分重要。

Objective To understand the composition of the pathogen spectrum and drug resistance of joint fluid samples from different populations and different years in Shandong Province and to provide reference for early clinical empirical treatment.Methods The WHONET 5.6 analysis software was used to retrospectively analyze the pathogen composition and drug susceptibility of 1,243 joint fluid samples reported by SPARSS network members in Shandong Province from 2017 to 2022.Results The main isolates in joint fluid were Escherichia coli(42.1%)and Staphylococcus aureus(19.1%).The composition ratio of male to female strains was 59:41.The composition of strains increased in different years,and 360 strains were isolated in 2019,the largest number in the past year.The bacteria isolated from the joint fluid of the children group and the young and middle-aged group were mainly gram-negative bacteria,and the bacteria isolated from the joint fluid of the elderly group were mainly Gram-positive bacteria.There were significant differences in the distribution of Gram-positive and Gram-negative bacteria in the children group,the young and middle-aged group,and the adult group(χ^(2)=42.84,P<0.0001).The proportion of ESBLs in Enterobacteriaceae was 49.8%,and the carbapenem-resistant E.coli was 1.0%.The rate of methicillin-resistant S.aureus was 29.8%.Conclusion The distribution of pathogenic bacteria in joint fluid varied among different populations and different years in Shandong Province,and there were great differences in the drug resistance of different pathogens to various antibiotics.Therefore,monitoring the distribution and drug resistance of pathogenic bacteria in different populations is very important to improve the diagnosis and treatment level of joint infections and guide clinically rational drug use.