2016—2020年某院血流感染分离菌分布和耐药性分析

doi:10.3969/j.issn.1000-8535.2021.06.020

摘要/Abstract

摘要： 目的探讨血培养分离菌的分布特点及耐药性,为临床科室诊治血流感染疾病和控制感染提供重要的参考依据。方法收集某院2016—2020年血培养阳性样本,采用细菌鉴定和药敏分析系统检测,用WHONET 5.6软件进行病原菌分布特点及药敏结果的整理分析。结果从血培养阳性标本分离出非重复菌3 424株,主要来自老年病科、危重症监护室、急诊留观室等。其中革兰阴性菌1 873株,常见有大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌等。近五年超广谱β-内酰胺酶革兰阴性耐药菌呈缓慢上升趋势,其余耐药菌变化趋势不大。革兰阴性菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、庆大霉素、妥布霉素、阿米卡星等总体耐药率均＜30%。革兰阳性菌1 328株,主要是葡萄球菌属,对达托霉素、替加环素均无耐药,对利奈唑胺、万古霉素、替考拉宁耐药率处于较低水平,对复方新诺明和克林霉素等的耐药率近五年呈缓慢下降趋势。结论血流感染主要常见分离菌为肠杆菌属和葡萄球菌属,临床应重视早期规范血培养和药敏结果,科学合理规范使用抗菌药。

关键词: 血流感染, 血培养, 病原菌, 抗菌药物, 耐药性分析

Abstract: Objective To investigate the distribution characteristics and drug resistance of isolates from blood culture, and to provide important reference for the diagnosis and treatment of bloodstream infection and infection control in clinical practice. Methods Positive blood culture samples of a hospital from 2016 to 2020 were collected and detected by bacteria identification and drug sensitivity analysis system. The distribution characteristics of pathogenic bacteria and drug sensitivity results were analyzed by WHONET 5.6 software. Results A total of 3 424 non-repeating strains were isolated from positive blood culture specimens, which were mainly from geriatrics department, critical care unit, emergency observation room, etc.Among them, 1 873 strains of Gram-negative bacteria were found, including Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. In recent five years, the extended-spectrum beta-lactamases Gram-negative drug resistant bacteria was slowly increasing, while other drug resistant bacteria showed little change. The overall drug resistance rates of Gram-negative bacteria to cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime, cefepime, gentamicin, tobramycin and amicacin were all less than 30%. There were 1 328 Gram-positive strains, mainly Staphylococcus, showed no resistance to datoromycin and tegacycline, and the resistance rates to linezolid, vancomycin and teicolanin were at a low level, while the resistance rates to cotrimoxazole and clindamycin showed a slow declining trend in recent five years. Conclusion Enterobacteria and Staphylococcus were the most common isolates of bloodstream infection. In clinical practice, attention should be paid to the early blood culture and drug sensitivity results, and the antimicrobial drugs should be used scientifically and rationally.

Key words: bloodstream infection, blood culture, pathogenic bacteria, antibacterial drugs, drug resistance analysis

杜燕, 吴斌, 杨潇. 2016—2020年某院血流感染分离菌分布和耐药性分析[J]. 广州医药, 2021, 52(6): 90-96.

DU Yan, WU Bin, YANG Xiao. Distribution and drug resistance analysis of bloodstream infection isolates in a hospital from 2016 to 2020[J]. Guangzhou Medical Journal, 2021, 52(6): 90-96.

参考文献

[1] LAMY B, SUNDQVIST M, IDELEVICH E A, et al. Bloodstream infections-standard and progress in pathogen diagnostics[J]. Clin Microbiol Infect, 2019, 26(2): 142-150.
[2] 胡付品,郭燕,朱德妹,等.2018年CHINET中国细菌耐药性监测[J]. 中国感染与化疗杂志,2020,20(1):1-10.
[3] 全国细菌耐药监测网. 2019年全国细菌耐药监测报告(简要版)[EB/OL]. (2020-11-19)[2021-05-30]. http://www.carss.cn/Report/Details/770.
[4] 何礼贤.临床医师如何分析和运用细菌耐药监测网数据[J]. 中国合理用药探索,2017,14(2):1-4.
[5] Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing[S] .Twenty-twenty informational supplement Wayne, PA: CLSI,2020.
[6] 黄湘宁,殷琳,张欣,等.2017年四川省细菌耐药监测报告[J]. 中国抗生素杂志,2018,43(9):1143-1150.
[7] 张荣芳,李轶,钱磊,等.重症医学科患者血流感染病原菌分布及耐药性分析[J]. 检验医学与临床,2021,18(11):1543-1545,1550.
[8] REDDY K, BEKKER A, WHITELAW A C,et al. A retrospective analysis of pathogen profile, antimicrobial resistance and mortality in neonatal hospital-acquired bloodstream infections from 2009-2018 at Tygerberg Hospital, South Africa[J]. PloS one,2021,16(1):e0245089.
[9] 张晓琳,焦红梅,刘新民. 老年患者血流感染预后的相关因素[J]. 中国老年学杂志,2015,35(23):6878-6882.
[10] 刘长德,张柳溪,翟涛,等.重症监护病房患者血流感染病原菌分布及耐药性分析[J]. 检验医学与临床,2020,17(21):3168-3172.
[11] 刘韶瑜,李姝,马青变,等.急诊血流感染患者的临床特征及预后分析[J]. 中华急诊医学杂志,2020,29(12):1595-1600.
[12] 刘存芬,王燕,杨溶,等.200株血流感染大肠埃希菌耐药性分析[J]. 检验医学,2020,35(12):1263-1266.
[13] 王瑞华,冯贺强,王玮,等.血流感染患者产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌耐药性及危险因素分析[J]. 中国抗生素杂志,2020,45(12):1262-1267.
[14] 卢丽明,邱芳华.2012～2014年血流感染的病原菌分布及耐药性分析[J]. 国际检验医学杂志,2016,37(24):3385-3387,3390.
[15] TZOUVELEKIS L, MARKOGIANNAKIS A, PSICHO-GIOU M, et al. Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae : an evolving crisis of global dimensions[J]. Clin Microbiol Rev, 2012, 25(4): 682-707.
[16] 喻华,徐雪松,李敏,等.肠杆菌目细菌碳青霉烯酶的实验室检测和临床报告规范专家共识[J]. 中国感染与化疗杂志,2020,20(6):671-680.
[17] 查翔远,陈诚,陈贤,等.肺炎克雷伯菌血流感染151例临床特征及预后分析[J]. 中国抗生素杂志,2020,45(12):1279-1282.
[18] FASIHI Y, SAFFARI F, MANSOURI S, et al. The emergence of vancomycin-resistant taphylococcus aureus in an intensive care unit in Kerman, Iran[J]. Wien Med Wochenschr, 2018, 168 (3-4):85-88.
[19] 陈静,吴佳玉,向钱,等.金黄色葡萄球菌血流感染139例临床分析[J]. 中国感染与化疗杂志,2020,20(4):368-373.