2018—2020年多中心血流感染分离菌分布及耐药性分析

摘要：目的 分析2018—2020年多中心血流感染病原菌的分布及耐药演变特点，为临床合理选用抗菌药物提供可靠依据。 方法 采用药敏纸片法或仪器法，对11所三级医院按统一技术方案，进行细菌鉴定及药物敏感性试验，按2020年CLSI折点标准 判断结果，数据分析使用WHONET5.6。结果 11所三级医院3年血流感染标本共分离病原菌20742株，其中革兰阴性菌12399 株 (59.8%)，革兰阳性菌8343株(40.2%)；排名前3的依次为大肠埃希菌(5231株，25.2%)、肺炎克雷伯菌(2840株，13.7%)、表皮葡 萄球菌(1517株，7.3%)。3年药敏结果表明，大肠埃希菌对环丙沙星的耐药率均高于60.0%(62.8%、63.6%和66.3%)；肺炎克雷伯 菌对碳青霉烯类耐药率逐年上升(16.7%、16.8%和21.6%)，其中空军军医大学第一附属医院、昆明医科大学第一附属医院最高 36.2%和30.6%；MRSA检出率逐年下降(32%、31.6%和30.7%)；非发酵革兰阴性杆菌铜绿假单胞菌对哌拉西林/他唑巴坦的耐药 率分别为10.2%、10.5%和7.5%；鲍曼不动杆菌对碳青霉烯类抗菌药物的耐药率较高(77.6%、76.7%和74.7%)；屎肠球菌检出率 高于粪肠球菌，除利奈唑胺和四环素外，屎肠球菌的耐药性均高于粪肠球菌；布鲁菌共检出300株，其中宁夏医科大学总医院 检出最多(165株)。结论 11所医院血流感染病原菌3年检出及构成变化不大，以革兰阴性菌为主，大肠埃希菌和肺炎克雷伯菌占 绝对优势；大肠埃希菌对喹诺酮类耐药率较高；鲍曼不动杆菌耐药情况严重；布鲁菌所有成员单位均有检出，宁夏医科大学总 医院检出数最多。临床应持续加强细菌耐药监测以指导临床合理用药。

Distribution and drug resistance analysis of bacteria from bloodstream infection of multicenters from 2018 to 2020

Abstract Objective To investigate the distribution and antimicrobial resistance evolution characteristics of multicenter bloodstream infection pathogens from 2018 to 2020 so as to provide guidance for reasonable clinical use of antimicrobial agents. Methods The Kirby-Bauer method or the instrument method was used to conduct bacterial identification and antibiotics susceptibility test in accordance with the unified technical plan. The result of antibiotics susceptibility test was defined according to the criteria of CLSI 2020, and the data were analyzed by WHONET5.6 software. Results A total of 20,742 strains of pathogenic bacteria were isolated from blood specimens from 11 tertiary A hospitals in three years, including 12,399 strains (59.8%) of Gram-negative bacteria and 8,343 strains (40.2%) of Gram-positive bacteria. The top 3 pathogens were Escherichia coli (5,231 strains, 25.2%), Klebsiella pneumoniae (2,840 strains, 13.7%), and Staphylococcus epidermidis (1,517 strains, 7.3%). Resistance rate of Escherichia coli to ciprofloxacin was relatively high (62.8%, 63.6%, 66.3%). Resistance rate of Klebsiella pneumoniae to carbapenems increased year by year (16.7 %, 16.8%, 21.6%), among which the First Affiliated Hospital of Air Force Medical University and the First Affiliated Hospital of Kunming Medical University havd the highest antimicrobial resistance rates (36.2%, 30.6%). The detection rate of MRSA is decreasing year by year (32%, 31.6%, 30.7%). Among non-fermenting sugar Gram-negative bacteria, the resistance rates of Pseudomonas aeruginosa to piperacillin/tazobactam were 10.2%, 10.5%, and 7.5%. Acinetobacter baumanii had a higher resistance rate to carbapenem antimicrobials (77.6%, 76.7%, 74.7%). The detection rate of Enterococcus faecium was higher than Enterococcus faecalis, and the resistance rates of Enterococcus faecium except for linezolid and tetracycline were higher than those of Enterococcus faecalis. A total of 300 strains of Brucella were detected, the most being from General Hospital of Ningxia Medical University (165 strains). Conclusion The detection rate and composition of bacteria from blood specimens in 11 hospitals have not changed much. The Gram negative bacteria were dominant, with Escherichia coli and Klebsiella pneumoniae gotting the edge. The antimicrobial resistance of Escherichia coli to quinolones is high. Acinetobacter baumanii showed serious antimicrobial resistance. Brucella was detected in all member units, and General Hospital of Ningxia University had the highest detection rate. It is necessary to strengthen surveillance on antimicrobial resistance of pathogens causing bloodstream and to guide use antimicrobial agents rationally.