2018—2020年多中心脑脊液分离菌分布及耐药性分析

摘要：目的 分析2018—2020年11家三级医院脑脊液分离出的病原菌的分布情况和抗生素耐药特征，为临床正确诊断及合理用药提供参考。方法 收集11家三级医院2018—2020年脑脊液标本中分离的菌株及药敏数据，使用WHONET5.6进行统计分析。结果 2018—2020年11家医院脑脊液标本阳性患者主要为中青年男性，共分离出2191株病原菌(剔除同一患者重复菌株)，其中革兰阳性菌1405(64.13%)株、革兰阴性菌752(34.32%)株、真菌34(1.55%)株。排在前五位的细菌分别为凝固酶阴性葡萄球菌1001(45.69%)株、鲍曼不动杆菌263(11.91%)株、肺炎克雷伯菌145(6.62%)株、屎肠球菌89(4.06%)株、大肠埃希菌74(3.38%)株。革兰阳性菌中其他主要病原菌为金黄色葡萄球菌73(3.33%)株、粪肠球菌49(2.24%)株、肺炎链球菌47(2.15%)株；革兰阴性菌中其他检出率较高的分别为阴沟肠杆菌47(2.15%)株、铜绿假单胞菌37(1.69%)株。药敏结果显示，耐甲氧西林的凝固酶阴性葡萄球菌和金黄色葡萄球菌检出率分别为78.4%和46.9%；葡萄球菌中未发现万古霉素、替考拉宁、利奈唑胺耐药株。鲍曼不动杆菌对纳入统计的抗生素耐药率在50.6%~92.6%，对第三代、四代头孢菌素及碳青霉烯类抗生素耐药率超过69.0%；肺炎克雷伯菌耐药率低于50%的仅为头孢替坦(17.4%)、美罗培南(32.0%)、阿米卡星(39.4%)和亚胺培南(41.2%)。屎肠球菌对青霉素、氨苄青霉素及氨基糖苷类抗生素的耐药率显著高于粪肠球菌。肺炎链球菌对青霉素耐药率超过70%。结论 11家医院中枢神经系统感染病原菌，凝固酶阴性葡萄球菌的占比最重，病原菌整体耐药情况较为严重，治疗过程中应重点关注不同病原菌的药敏结果，合理选择抗生素。

Distribution and drug resistance of multicenter cerebrospinal fluid isolates from 2018 to 2020

Abstract Objective To analyze the distribution and antibiotic resistance of pathogens isolated fromcerebrospinal fluid in 11 tertiary hospitals from 2018 to 2020, so as to provide reference for clinical correct diagnosisand rational drug use. Methods The strains isolated from cerebrospinal fluid samples of 11 tertiary hospitals from2018 to 2020 were collected and analyzed by WHONET5.6. Results From 2018 to 2020, the patients with positivecerebrospinal fluid specimens in 11 hospitals were mainly young and middle-aged men. A total of 2191 strains ofbacteria were isolated(excluding the repeated strains of the same patient), including 1405 strains of Gram-positivebacteria(64.13%), 752 strains of Gram-negative bacteria(34.32%) and 34 strains of fungi(1.55%). The top fivebacteria were coagulase-negative Staphylococcus (45.69%, 1001 strains), Acinetobacter baumannii (11.91%, 263strains), Klebsiella pneumoniae (6.62%, 145 strains), Enterococcus faecium (4.06%, 89 strains), Escherichia coli(3.38%, 74 strains). Other major pathogens in Gram-positive bacteria were 73(3.33%) strains of Staphylococcusaureus, 49(2.24%) strains of Enterococcus faecalis, and 47(2.15%) strains of Streptococcus pneumoniae. The otherGram-negative bacteria with high detection rates were Enterobacter cloacae (2.15%, 47 strains) and Pseudomonasaeruginosa (1.69%, 37 strains), respectively. The results of drug sensitivity showed that the detection rates ofmethicillin resistant coagulase negative Staphylococcus and Staphylococcus aureus were 78.4% and 46.9%,respectively. No vancomycin, teicoplanin and linezolid resistant strains were found in Staphylococcus. The resistancerates of Acinetobacter baumannii to the included antibiotics were 50.6%~92.6%, and the resistance rate to the thirdand fourth generation cephalosporins and carbapenems were more than 69.0%. The resistance rates of Klebsiellapneumoniae less than 50% were only 17.4%(cefotetan), 32.0%(meropenem), 39.4%(amikacin) and 41.2%(imipenem).The resistance rates of Enterococcus faecium to penicillin, ampicillin and aminoglycoside antibiotics weresignificantly higher than those of Enterococcus faecalis. Streptococcus pneumoniae resistant to penicillin was over70%. Conclusion Coagulase-negative staphylococci accounted for the largest proportion of patients with centralsystem infection in 11 hospitals, and the overall drug resistance of pathogenic bacteria was relatively serious. The drugsensitivity results of different pathogenic bacteria should be paid attention to in the treatment process, and antibioticsshould be reasonably selected.