2010-2019年某三级甲等医院非发酵革兰氏阴性杆菌的分布及耐药性分析
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篇名: 2010-2019年某三级甲等医院非发酵革兰氏阴性杆菌的分布及耐药性分析
TITLE: Analysis of Distribution and Drug Resistance of Non-fermentative Gram-negative Bacilli in a Tertiary Hospital from 2010 to 2019
摘要: 目的:为临床经验性治疗非发酵革兰氏阴性杆菌(NFGNB)感染提供参考依据。方法:收集陕西汉中市某三级甲等医院2010年1月-2019年12月临床送检的各类标本,回顾性分析NFGNB的分布及耐药情况。结果:2010-2019年,该院共检出病原菌26386株,其中NFGNB4077株(占15.45%),主要来源于年龄≥60岁的患者(1836株,占45.05%)。10年间,NFGNB的检出率由2010年的20.14%降至2019年的15.36%(P<0.001)。检出菌种以鲍曼不动杆菌(1359株)、铜绿假单胞菌(1269株)、嗜麦芽窄食单胞菌(447株)、洋葱伯克霍尔德菌(351株)等为主。检出的NFGNB主要来源于住院患者(4001株),且多见于重症监护病区(占17.05%)、神经外科(占14.52%)、呼吸科(占12.41%)等科室以及呼吸道(占66.69%)、分泌物(占7.80%)等标本。其中,鲍曼不动杆菌和铜绿假单胞菌在肿瘤科的检出率以及在血液和尿液标本中的检出率均总体呈上升趋势,而在该院重症监护病区的检出率总体呈下降趋势(P<0.05);铜绿假单胞菌在神经外科的检出率呈上升趋势(P<0.05),鲍曼不动杆菌在呼吸科的检出率呈上升趋势(P<0.05)。鲍曼不动杆菌对碳青霉烯类抗菌药物的耐药率由2010年的10%左右升至2019年的75%左右,对头孢菌素类药物的耐药率超过了78%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别低于35%和30%,且耐药趋势变化不大(P>0.05),而对哌拉西林、氨曲南等12种临床常用抗菌药物的耐药率均低于40%;嗜麦芽窄食单胞菌对复方磺胺甲噁唑的耐药率逐渐呈现下降趋势(P<0.001),对头孢他啶的耐药率较高(54.70%~74.10%);洋葱伯克霍尔德菌对复方磺胺甲噁唑、美罗培南、头孢他啶的耐药率均呈现下降趋势(P<0.01),且在2014年之后均低于15%。结论:该院NFGNB的检出率虽有下降趋势,但鲍曼不动杆菌多重耐药和泛耐药情况较为严重,且对碳青霉烯类抗生素的耐药率有所上升;临床应根据药敏试验结果合理选用头孢哌酮/舒巴坦、阿米卡星、左氧氟沙星、头孢他啶等敏感药物治疗NFGNB感染。
ABSTRACT: OBJECTIVE:To provide reference for clinical empirical treatme nt of non-fermentative Gram-negative bacilli (NFGNB)infection. METHODS :All kinds of clinical specimens were collected from Jan. 2010 to Dec. 2019 in a tertiary hospital from Hanzhong city of Shaanxi province ;the distribution and drug resistance of NFGNB were analyzed retrospectively. RESULTS : A total of 26 386 strains of pathogenic bacteria were detected in the hospital during 2010-2019,including 4 077 strains of NFGNB (15.45%),mainly from patients ≥60 years old (1 836 strains,45.05%). During the 10 years,the detection rate of NFGNB decreased from 20.14% in 2010 to 15.36% in 2019 (P<0.001). Acinetobacter baumannii (1 359 strains),Pseudomonas aeruginosa (1 269 strains),Stenotrophomonas maltophilia (447 strains) and Burkholderia cepacia (351 strains) were main pathogens. The detected NFGNB mainly came from hospitalized patients (4 001 strains),and most of them were found in ICU (17.05%),neurosurgery department (14.52%),respiratory department (12.41%),and respiratory tract (66.69%),secretion (7.80%)specimens. The detection rates of A. baumannii and P. aeruginosa in oncology department ,blood specimens and urine specimens showed an overall upward trend ,while the detection rates in ICU of the hospital showed a downward trend (P<0.05); the detection rate of P. aeruginosa in neurosurgery department showed an upward trend (P<0.05),and that of A. baumannii in respiratory department showed an upward trend (P<0.05). The resistance rate of A. baumannii to carbapenems increased from about 10% in 2010 to about 75% in 2019,and the guyh3201@163.com resistance rate to cephalosporins exceeded 78%. The resistance rates of P. aeruginosa to imipenem and me ropenem were lower than 35% and 30% respectively,and the trend of drug resistance did not change significantly (P>0.05);the resistance rates to 12 kinds of clinically commonly used antibiotics as piperacillin and aztreonam were lower than 40%. The resistance rate of S. maltophilia to compound sulfamethoxazole showed a decreasing trend (P<0.001),and the resistance rate to ceftazidime was high (54.70%-74.10%). The resistance rates of B. cepacia to compound sulfamethoxazole,meropenem and ceftazidime showed a downward trend (P<0.01),and were lower than 15% after 2014. CONCLUSIONS:Although the detection rate of NFGNB in our hospital showed a downward trend ,the multi-drug resistance and pan-drug resistance of A. baumannii are serious ,and the resistance rate to carbapenems is increased. Sensitive drugs such as cefoperazone/sulbactam,amikacin,levofloxacin and ceftazidime should be selected for NFGNB infection according to the results of drug sensitivity tests.
期刊: 2020年第31卷第23期
作者: 辜依海,张微,侯轩,王辉,邓明惠,陶浚齐,周梦蓉,翁蕊
AUTHORS: GU Yihai,ZHANG Wei,HOU Xuan,WANG Hui,DENG Minghui ,TAO Junqi,ZHOU Mengrong ,WENG Rui
关键字: 非发酵革兰氏阴性杆菌;耐药变迁;鲍曼不动杆菌;铜绿假单胞菌
KEYWORDS: Non-fermentative Gram-negative bacilli ;Drug resistance transition ;Acinetobacter baumannii ;Pseudomonas
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