2019—2022年我院血流感染病原菌分布及耐药性分析

doi:10.16138/j.1673-6087.2023.06.009

摘要/Abstract

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

中图分类号:

R181.3

杨思恒, 张学武, 胡国启, 张彦, 李自强, 盛滋科, 徐玉敏. 2019—2022年我院血流感染病原菌分布及耐药性分析[J]. 内科理论与实践, 2023, 18(06): 424-430.

YANG Siheng, ZHANG Xuewu, HU Guoqi, ZHANG Yan, LI Ziqiang, SHENG Zike, XU Yumin. Analysis of distribution and drug resistance of pathogenic bacteria of bloodstream infection in a tertiary hospital from 2019 to 2022[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(06): 424-430.

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病原菌	2019—2020年		2021—2022年		合计
病原菌	株数（n=226）	构成比（%）	株数（n=442）	构成比（%）	株数（n=668）	构成比（%）
革兰阴性菌	164	72.57	297	67.19	461	69.01
大肠埃希菌	106	46.90	168	38.01	274	41.01
肺炎克雷伯菌	24	10.62	67	15.16	91	13.62
铜绿假单胞菌	10	4.42	13	2.94	23	3.44
鲍曼不动杆菌	5	2.21	11	2.49	16	2.40
嗜麦芽窄食单胞菌	6	2.65	5	1.13	11	1.65
洋葱伯克霍尔德菌	3	1.32	7	1.58	10	1.50
其他革兰阴性菌	10	4.42	26	5.88	36	5.39
革兰阳性菌	62	27.43	143	32.35	205	30.69
金黄色葡萄球菌	13	5.75	21	4.75	34	5.09
凝固酶阴性葡萄球菌	48	21.24	93	21.04	141	21.10
屎肠球菌	1	0.44	11	2.49	12	1.80
粪肠球菌	0	0	5	1.13	5	0.75
其他革兰阳性菌	0	0	13	2.94	13	1.95
真菌	0	0	2	0.46	2	0.30
白色念珠菌	0	0	1	0.23	1	0.15
光滑念珠菌	0	0	1	0.23	1	0.15

抗菌药物	大肠埃希菌（n=274）					肺炎克雷伯菌（n=91）
抗菌药物	2019—2020年	2021—2022年	χ²	P	合计	2019—2020年	2021—2022年	χ²	P	合计
阿米卡星	0.94	4.76	2.983	0.084	3.28	12.50	7.46	0.559	0.455	8.79
氨苄西林	88.68	88.02	0.027	0.870	88.32	100.00	89.55	2.716	0.099	92.31
氨苄西林/舒巴坦	60.38	51.19	1.725	0.189	54.74	25.00	22.39	0.068	0.794	23.08
氨曲南	41.90	36.76	0.658	0.417	39.00	16.67	17.86	0.016	0.899	17.40
亚胺培南	0.94	1.79	0.321	0.571	1.46	12.50	5.97	1.061	0.303	6.59
厄他培南	0.94	1.79	0.321	0.571	1.46	12.50	5.97	1.061	0.303	6.59
呋喃妥因	96.19	84.33	7.919	0.004	90.96	100.00	81.82	4.877	0.027	89.47
复方磺胺甲噁唑	52.83	60.12	1.411	0.235	57.30	8.33	29.85	4.463	0.035	24.18
环丙沙星	60.00	62.77	0.193	0.660	56.20	20.83	30.36	0.764	0.382	27.50
哌拉西林/他唑巴坦	3.75	8.33	2.202	0.138	6.57	12.50	10.45	0.076	0.783	10.99
庆大霉素	44.76	31.85	4.200	0.040	37.50	12.50	30.91	2.995	0.084	22.37
替加环素	0	0	-	-	0	0	0	-	-	0
头孢吡肟	27.36	37.35	2.900	0.089	33.46	16.67	17.91	0.019	0.891	17.58
头孢曲松	67.92	57.14	3.185	0.074	61.31	20.83	31.34	0.956	0.328	28.57
头孢他啶	30.19	27.97	0.155	0.694	22.38	12.50	16.42	0.208	0.648	15.38
头孢替坦	3.77	7.78	1.786	0.181	3.23	12.50	13.43	0.013	0.908	13.19
妥布霉素	15.64	17.89	0.286	0.593	16.67	12.50	8.16	0.350	0.554	9.59
左氧氟沙星	51.89	52.69	0.017	0.896	52.38	16.67	31.34	1.910	0.166 7	27.47

抗菌药物	铜绿假单胞菌（n=23）	鲍曼不动杆菌（n=16）	嗜麦芽窄食单胞菌（n=11）	洋葱伯克霍尔德菌（n=10）
阿米卡星	0	-	-	100.00
氨苄西林/舒巴坦	-	68.79	-
氨曲南	-		-	100.00
亚胺培南	17.39	50.00	-	60.00
复方磺胺甲噁唑		31.25	0	0
环丙沙星	30.43	68.75	-	100.00
哌拉西林/他唑巴坦	21.74	42.85	-	50.00
庆大霉素	5.26	62.50	-	60.00
头孢吡肟	17.39	50.00	-	50.00
头孢曲松	-	62.50	-	-
头孢他啶	17.39	62.50	71.43	10.00
妥布霉素	4.35	56.25	-	70.00
左氧氟沙星	30.43	50.00	22.22	80.00

抗菌药物	金黄色葡萄球菌（n=34）					凝固酶阴性葡萄球菌（n=141）
抗菌药物	2019—2020年	2021—2022年	χ²	P	合计	2019—2020年	2021—2022年	χ²	P	合计
苯唑西林 MIC	76.92	76.19	0.002	0.961	76.47	87.50	82.79	0.532	0.466	84.39
头孢西丁筛选阳性	76.92	76.19	0.002	0.961	76.47	85.42	81.72	0.306	0.580	82.98
复方磺胺甲噁唑	38.46	19.05	1.555	0.212	26.47	43.75	52.69	1.012	0.315	49.65
红霉素	76.92	61.90	0.828	0.363	67.65	85.42	84.95	0.006	0.941	85.11
环丙沙星	30.77	14.29	1.334	0.248	20.59	41.67	47.31	0.407	0.524	45.39
克林霉素	76.92	47.62	2.847	0.092	58.82	68.75	52.69	3.356	0.067	58.16
奎奴普丁/达福普汀	0	0	-	-	0	0	0	-	-	0
利福平	0	4.76	0.638	0.425	2.94	0	4.30	2.125	0.145	2.84
利奈唑胺	0	0	-	-	0	0	0	-	-	0
莫西沙星	15.38	14.29	0.008	0.930	14.71	18.75	36.56	4.737	0.029	30.50
青霉素	100	100	-	-	100	91.67	91.40	0.003	0.957	91.49
庆大霉素	30.77	9.82	2.494	0.114	17.65	18.75	15.05	0.317	0.573	16.31
四环素	15.38	0	3.433	0.064	5.88	33.33	33.33	-	-	33.33
替加环素	0	0	-	-	0	0	0	-	-	0
万古霉素	0	0	-	-	0	0	0	-	-	0
左氧氟沙星	23.08	19.05	0.080	0.778	20.59	33.33	46.24	2.166	0.141	41.84