某三甲医院2018 - 2020年血流感染病原菌分布及其耐药性分析

鲍金凤; 叶丽艳; 麻雅婷; 刘思玲; 杨继勇; 罗燕萍; 王成彬

doi:10.3969/j.issn.2095-5227.2021.05.010

某三甲医院2018 - 2020年血流感染病原菌分布及其耐药性分析

Pathogenic spectrum of blood stream infections and realated drug resistance in a grade A territory hospital from 2018 to 2020

摘要

摘要:
背景住院病人血流感染的发病率逐年升高，引起了广大临床工作者的高度重视。
目的探讨我中心2018 - 2020年血培养病原菌的分布及耐药性变迁，为临床血流感染的诊治提供依据。
方法使用VITEK MS质谱仪进行细菌鉴定，VITEK 2 Compact细菌鉴定药敏仪进行抗菌药物敏感性试验，数据采用WHONET 5.6软件进行统计分析。
结果我中心2018 - 2020年3 574例患者血培养阳性，其中男性多于女性, 平均年龄58.26岁，60岁以上患者占53.05% (1 896/3 574)。血培养阳性率排名前3位的科室分别为急诊科、重症监护室及肿瘤科。急诊血培养阳性患者多存在发热或腹痛等急性症状，且伴有不同组织脏器病变，以肺部感染最为常见。共检出非重复病原菌4 426株，其中革兰阳性菌占57.82%，革兰阴性菌占38.12%，真菌占4.07%。前5位分离菌依次为凝固酶阴性葡萄球菌(1 505株，34.00%)、大肠埃希菌(659株，14.89%)、肺炎克雷伯菌(469株，10.60%)、屎肠球菌(235株，5.31%)和金黄色葡萄球菌(135株，3.05%)。2018 - 2020年大肠埃希菌对亚胺培南耐药率分别为3.04%、2.54%、2.52%，总体耐药率为2.58%；肺炎克雷伯菌对亚胺培南的耐药率分别为40.24%、33.33%、57.05%，总体耐药率为43.71%；鲍曼不动杆菌对亚胺培南的耐药率分别为73.68%、80.36%、75.00%，总体耐药率为76.40%；铜绿假单胞菌对亚胺培南的耐药率分别为18.52%、28.00%、39.29%，总体耐药率为26.17%。2018 - 2020年耐甲氧西林金黄色葡萄球菌的检出率分别为29.63%、17.39%、26.47%，总体检出率为26.61%。
结论解放军总医院第一医学中心血培养病原菌以凝固酶阴性葡萄球菌、大肠埃希菌和肺炎克雷伯菌为主，碳青霉烯耐药肺炎克雷伯菌和鲍曼不动杆菌的检出率较高，临床应高度重视。

Abstract:
Background The increasing incidence of bloodstream infection of hospitalized patients has aroused great concern of clinical workers.
Objective To investigate the pathogenic profile and antimicrobial resistance in blood stream infections in our center from 2018 to 2020, and provide evidence for the diagnosis and treatment of clinical bloodstream infection.
Methods VITEK 2 Compact bacterial identification system and IVITEK MS mass spectrometry were used for bacterial identification, antimicrobial susceptibility test was carried out by VITEK 2 Compact and analyzed by WHONET 5.6.
Results From 2018 to 2020, a total of 3 574 patients had positive blood culture results. There were 2 324 males and 1 250 females, with an average age of 58.26 years, and 52.86% (1 896/3 574) of whom were over 60 years old. The departments with top three incidences of blood stream infections were emergency department, intensive care unit and oncology department. Patients with positive blood culture in emergency department usually had acute symptoms such as fever or abdominal pain, accompanied by pathological changes of different tissues and organs, and pulmonary infection was common seen. Totally 4 426 non-repetitive pathogenic strains were detected in our study, including Gram-positive bacteria (57.82%), Gram-negative bacteria (38.12%) and fungus (4.07%); and the top five isolated bacteria were coagulase-negative Staphylococci (1 505 strains, 34.00%), E. coli (659 strains, 14.89%), K. pneumoniae (469 strains, 10.60%), E. enterococcus (235 strains, 5.31%) and S. aureus (135 strains, 3.05%). In 2018, 2019, and 2020, the drug resistance rate of E. coli to imipenem was 3.04%, 2.54% and 2.52%, respectively, with a total rate of 2.58%; The resistance rate of K. pneumoniae to imipenem was 40.24%, 33.33%, 57.05%, respectively, with a total rate of 43.71%; The resistance rate of A. baumanni to imipenem was 73.68%, 80.36% and 75.00%, respectively, with a total rate of 76.40%; The resistance rate of P. aeruginosa to imipenem was 18.52%, 28.00% and 39.29%, respectively, with a total rate of 26.17%; The three-year detection rates of Methicillin-resistant S. aureus was 29.63%, 17.39% and 26.47%, respectively, with a total rate of 26.61%.
Conclusion The pathogens of blood stream infections in our hospital are mainly coagulase-negative Staphylococci, E. coli and K. pneumoniae. The detection rates of carbapenems drug-resistant K. pneumoniae and A. baumannii are high, which suggests that close attention should be paid to clinical drug use.

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