摘要
目的探讨武汉市第三医院血流感染病原菌的分布及耐药性变迁,为合理使用抗菌药物提供依据。方法收集武汉市第三医院2012年1月至2021年12月血流感染患者临床资料、菌株分布和体外药敏数据。结果共收集患者2091例,社区获得性60.8%(1272/2091),医院获得性39.2%(819/2091)。分离菌株2262株,主要分布:烧伤科482株(21.3%)、重症监护室353株(15.6%)和肾内科225株(9.9%)。分离的菌株中革兰阴性菌1174株(51.9%),革兰阴性菌分离率由2012年38.6%升至2021年54.7%,居前3位的分别是大肠埃希菌(568株,25.1%)、肺炎克雷伯菌(170株,7.52%)和铜绿假单胞菌(152株,6.72%);革兰阳性菌1088株(48.1%),居前3位的分别是凝固酶阴性葡萄球菌(556株,24.5%)、金黄色葡萄球菌(339株,14.9%)和肠球菌属(93株,4.11%)。2012—2016年与2017—2021年相比,大肠埃希菌对氨苄西林的耐药率由81.1%上升至82.6%,对头孢唑林的耐药率由57.2%上升至64.5%,对环丙沙星耐药率由41.8%下降至38.7%,对哌拉西林/他唑巴坦、阿米卡星、亚胺培南耐药率均<5%。肺炎克雷伯菌对头孢吡肟耐药率由4.8%升至22.6%,对哌拉西林/他唑巴坦耐药率由3.2%升至12.3%,对亚胺培南耐药率由0升至8.5%。铜绿假单胞菌对环丙沙星耐药率由64.3%下降至44.1%,对亚胺培南耐药率由65.5%下降至61.8%。鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率为81.5%,对多黏菌素耐药率为2.9%,对亚胺培南耐药率由82.8%下降至73.5%。耐甲氧西林金黄色葡萄球菌(MRSA)分离率53.1%(180/339),耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分离率64.3%(358/556),金黄色葡萄球菌对苯唑西林耐药率由58.1%下降至43.6%,凝固酶阴性葡萄球菌对苯唑西林耐药率由81.8%下降至57.4%。结论武汉市第三医院血流感染病原体构成中革兰阴性菌呈增长趋势;大肠埃希菌、肺炎克雷伯菌对常用药物的耐药性增加;葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌对常用药物的耐药率呈轻度下降趋势,但耐药形势依然严峻。
Objective To analyze the distribution and drug resistance of pathogens of bloodstream infection in our medical institution,and to offer evidence for the rational use of antibiotics.Methods The clinical data,strain distribution,and antimicrobial susceptibility data of patients with bloodstream infections in our hospital from January 2012 to December 2021 were collected.Results Data of 2091 patients were collected,with the community acquired 60.8%(1,272/2,091)and hospital acquired 39.2%(819/2,091).There were 2,262 positive strains in blood culture,including 482 strains(21.3%)in the burn department,353 strains(15.6%)in the intensive care unit,and 225 strains(9.9%)in the nephrology department,among which 1,174 strains(51.9%)were Gram-negative bacteria.The isolation rate of Gram-negative bacteria increased from 38.6%to 54.7%from 2012 to 2021.The top three were Escherichia coli(568 strains,25.1%),Klebsiella pneumoniae(170 strains,7.52%),and Pseudomonas aeruginosa(152 strains,6.72%).There were 1,088 Gram-positive strains(48.1%),including 556 Coagulase-negative Staphylococcus(24.5%),339 Staphylococcus aureus(14.9%)and 93 enterococcus(4.11%)in the top three.Compared with 2017-2021,the resistance rates of Escherichia coli to ampicillin and cefazolin increased from 81.1%and 57.2%to 82.6%and 64.5%,ciprofloxacin decreased from 41.8%to 38.7%,and piperacillin/trizobactam,amikacin and imipenem were all<5%.The drug resistance rates of Klebsiella pneumoniae to cefepime,piperacillin/tazobactam,and imipenem increased from 4.8%,3.2%,and 0 to 22.6%,12.3%,and 8.5%.The resistance rates of P.aeruginosa to ciprofloxacin and imipenem decreased from 64.3%and 65.5%to 44.1%and 61.8%.The resistance rates of Acinetobacter baumannii to cefoperazone/sulbactam and polymyxin were 81.5%and 2.9%,while imipenem decreased from 82.8%to 73.5%.The isolation rate of methicillin-resistant Staphylococcus aureus(MRSA)and methicillin-resistant Coagulase-negative Staphylococcus(MRCNS)was 53.1%(18/339)and 64.3%(358/556),respectively.The drug resistance rates of Staphylococcus aureus and Coagulase-negative Staphylococcus to oxacillin decreased from 58.1%and 81.8%to 43.6%and 57.4%.Conclusion The drug resistance of Pseudomonas aeruginosa and Acinetobacter baumannii is imminence to all of us,however,our statistics show that the drug resistance rate is decreasing.
作者
王盼
别甜敏
金文平
王华兵
蒋雯
Wang Pan;Bie Tian-min;Jin Wen-ping;Wang Hua-bing;Jiang Wen(Wuhan Third Hospital,Wuhan 430060)
出处
《中国抗生素杂志》
CAS
CSCD
北大核心
2023年第4期445-452,共8页
Chinese Journal of Antibiotics
基金
武汉市卫生健康委医学科研基金资助(No.WX21Z38)。
关键词
血流感染
病原菌
耐药率变迁
革兰阴性菌
革兰阳性菌
Bloodstream infection
Bacterial pathogens
Drug resistance rate
Gram-negative bacteria
Gram-positive bacteria
