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

doi:10.16138/j.1673-6087.2023.06.009

Abstract

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

CLC Number:

R181.3

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.

Figures/Tables 7

References 27

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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