内科理论与实践 ›› 2023, Vol. 18 ›› Issue (06): 424-430.doi: 10.16138/j.1673-6087.2023.06.009

• 研究报道 • 上一篇    下一篇

2019—2022年我院血流感染病原菌分布及耐药性分析

杨思恒1a, 张学武1a, 胡国启1a, 张彦1a, 李自强1b, 盛滋科2a, 徐玉敏2b()   

  1. 1.界首市人民医院 a. 感染科;b. 检验科,安徽 界首 236500
    2.上海交通大学医学院附属瑞金医院 a. 感染科;b. 感染管理科,上海 200025
  • 收稿日期:2023-05-18 出版日期:2023-12-18 发布日期:2024-03-18
  • 通讯作者: 徐玉敏 E-mail: xym121@163.com
  • 基金资助:
    2021年度阜阳市卫生健康委科研项目(FY2021-187)

Analysis of distribution and drug resistance of pathogenic bacteria of bloodstream infection in a tertiary hospital from 2019 to 2022

YANG Siheng1a, ZHANG Xuewu1a, HU Guoqi1a, ZHANG Yan1a, LI Ziqiang1b, SHENG Zike2a, XU Yumin2b()   

  1. 1a. Department of Infectious Diseases; 1b. Department of Laboratory Medicine, Jieshou People’s Hospital, Jieshou 236500, China
    2a. Department of Infectious Diseases; 2b. Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2023-05-18 Online:2023-12-18 Published:2024-03-18

摘要:

目的:分析界首市人民医院住院患者血流感染(bloodstream infection, BSI)病原菌分布及耐药情况,为本地区BSI患者治疗及院内感染防控提供临床指导依据。方法:从本院实验室信息系统(laboratory information system, LIS)中筛选2019年01月至2022年12月期间住院患者6 727例血培养标本,分离到菌株668株(9.93%),回顾性分析菌种分布和耐药情况。用Excel 2021、WHONET 5.6软件进行统计分析。结果:病原菌分离主要来自感染科、重症监护室、普外科等,呼吸系统、泌尿系统、肝胆系统感染等引起的BSI最常见,30 d死亡率为23.50%。668株分离菌种中革兰阴性菌461株(69.01%)、革兰阳性菌205株(30.69%)、真菌2株(0.30%);分离前5位(84.28%)菌种分别是大肠埃希菌274株(41.01%)、凝固酶阴性葡萄球菌141株(21.10%)、肺炎克雷伯菌91株(13.62%)、金黄色葡萄球菌34株(5.09%)、铜绿假单胞菌23株(3.44%)。2021—2022年较2019—2020年大肠埃希菌检出率有所下降(P<0.05),肺炎克雷伯菌检出率轻度增加(P>0.05)。大肠埃希菌、肺炎克雷伯菌对碳青霉烯类、哌拉西林/他唑巴坦、阿米卡星耐药率均较低,碳青霉烯类耐药肠杆菌目细菌(carbapenem-resistant Enterobacterales, CRE)所占比例较低(6.09%)。金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)占比较高(76.47%),包括肠球菌在内的革兰阳性菌均未检出对万古霉素、利奈唑胺、替加环素耐药菌株。结论:本地区BSI菌种以革兰阴性菌大肠埃希菌、肺炎克雷伯菌和革兰阳性菌凝固酶阴性葡萄球菌、金黄色葡萄球菌为主。其中主要革兰阴性菌对碳青霉烯类、阿米卡星、哌拉西林/他唑巴坦有较高敏感性。MRSA有较高的检出率。

关键词: 血流感染, 血培养, 病原菌分布, 耐药性, 抗菌药物, 流行病学

Abstract:

Objective To analyze the distribution and the drug resistance of bloodstream infection(BSI) pathogenic bacteria in hospitalized patients in Jieshou People’s Hospital, provide a basis for clinical guidance on the treatment of BSI patients, and prevent and control nosocomial infection in local area. Methods From January in 2019 to December in 2022, 6 727 blood culture samples of inpatients were screened from the laboratory information system (LIS) in our hospital, and 668 (9.93%) strains were isolated, and the distribution and drug resistance of the bacteria were analyzed retrospectively. Statistical analysis was performed using Excel 2021 and WHONET 5.6 software. Results Pathogens were mainly isolated from infection department, intensive care unit, general surgery. BSI caused by respiratory system infection, urinary system infection, and hepatobiliary system infection was the most common, and 30-day mortality rate of patients was 23.50%. Among the 668 isolated strains, 461(69.01%) strains were Gram-negative bacteria, 205(30.69%) strains were Gram-positive bacteria and 2(0.30%) strains were fungi. The top five isolated strains(84.28%) were 274 (41.01%) strains of Escherichia coli, 141(21.10%) strains of coagulase-negative Staphylococcus, 91(13.62%) strains of Klebsiella pneumoniae, 34(5.09%) strains of Staphylococcus aureus and 23(3.44%) strains of Pseudomonas aeruginosa, respectively. The detection rate of Escherichia coli in 2021-2022 was decreased compared with 2019-2020 (P<0.05), while the detection rate of Klebsiella pneumoniae was increased slightly in 2021-2022 compared with 2019-2020 (P>0.05). The resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems, piperacillin/tazobactam, and amikacin were low, and the proportion of carbapenem-resistant Enterobacterales (CRE) was low (6.09%). Among Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA) accounted for a relatively high proportion (76.47%), while Gram-positive bacteria including Enterococcus were not detected to be resistant to vancomycin, linezolid and tigecycline. Conclusions Escherichia coli, Klebsiella pneumoniae in Gram-negative bacteria, and the coagulase-negative Staphylococcus and Staphylococcus aureus in Gram-positive bacteria were the main strains of BSI in local area. The main Gram-negative bacteria were highly sensitive to carbapenems, amikacin, piperacillin/tazobactam. MRSA has a higher detection rate.

Key words: Bloodstream infection, Blood culture, Distribution of pathogenic bacteria, Drug resistance, Antimicrobial drugs

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