欢迎来到《四川大学学报(医学版)》 2025年4月4日 星期五

某三甲教学医院2016−2020年血标本病原菌耐药性变迁

邓劲, 康梅, 谢轶, 马莹

邓劲, 康梅, 谢轶, 等. 某三甲教学医院2016−2020年血标本病原菌耐药性变迁[J]. 四川大学学报(医学版), 2022, 53(4): 688-695. DOI: 10.12182/20220760506
引用本文: 邓劲, 康梅, 谢轶, 等. 某三甲教学医院2016−2020年血标本病原菌耐药性变迁[J]. 四川大学学报(医学版), 2022, 53(4): 688-695. DOI: 10.12182/20220760506
DENG Jin, KANG Mei, XIE Yi, et al. Changes and Trends of Drug Resistance of Pathogenic Bacteria in Blood Samples of a Tertiary-Level Teaching Hospital from 2016 to 2020[J]. Journal of Sichuan University (Medical Sciences), 2022, 53(4): 688-695. DOI: 10.12182/20220760506
Citation: DENG Jin, KANG Mei, XIE Yi, et al. Changes and Trends of Drug Resistance of Pathogenic Bacteria in Blood Samples of a Tertiary-Level Teaching Hospital from 2016 to 2020[J]. Journal of Sichuan University (Medical Sciences), 2022, 53(4): 688-695. DOI: 10.12182/20220760506

某三甲教学医院2016−2020年血标本病原菌耐药性变迁

基金项目: 四川省科技厅重点研发项目(No. 2020YFS0555)资助
详细信息
    通讯作者:

    马莹: E-mail:maying72@hotmail.com

Changes and Trends of Drug Resistance of Pathogenic Bacteria in Blood Samples of a Tertiary-Level Teaching Hospital from 2016 to 2020

More Information
  • 摘要:
      目的  了解本院2016−2020年间血液标本病原菌分布及耐药变迁,为临床血流感染诊治提供依据。
      方法  使用Bruker MALDI-TOF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,部分采用纸片扩散法,数据采用WHONET 5.6软件进行统计分析。
      结果  2016−2020年本院临床血液标本来源分离菌株共8931株,其中革兰阳性菌4502株(50.4%),革兰阴性菌4429株(49.6%)。肠杆菌目细菌大肠埃希菌(1773株,19.9%)居首位,其次是肺炎克雷伯菌(1067株,11.9%),非发酵菌以鲍曼不动杆菌(293株,3.3%)和铜绿假单胞菌(238株,2.7%)为主,葡萄球菌菌种前三位分布为表皮葡萄球菌(970株,10.9%)、人葡萄球菌(713株,8.0%)和金黄色葡萄球菌(541株,6.1%)。大肠埃希菌对头孢哌酮/舒巴坦、阿米卡星、多粘菌素B、替加环素及碳青霉烯类药敏的体外活性较高,敏感率均在90%以上,对亚胺培南的耐药率有缓慢上升的趋势,美罗培南的耐药率为2.2%~3.4%。肺炎克雷伯菌对常见抗生素体外耐药率高于大肠埃希菌,仅替加环素和多粘菌素B的敏感率大于90%,亚胺培南和美罗培南的耐药率逐年升高。铜绿假单胞菌自2017年起对亚胺培南耐药率有下降(25.6%~18.6%),鲍曼不动杆菌对亚胺培南和美罗培南的耐药率为73.7%~91.3%和73.0%~91.3%。未发现对万古霉素、利奈唑胺耐药的葡萄球菌属细菌。肠球菌对万古霉素和利奈唑胺的耐药性均较低。
      结论  本院临床血液标本常见病原菌菌种分布无明显改变,但多重耐药菌的耐药形势日趋严峻,特别是耐碳青霉烯类肺炎克雷伯菌。

     

    Abstract:
      Objective  To investigate the distribution of pathogenic bacteria in blood samples and changes in their drug resistance in our hospital from 2016 to 2020, and to provide evidence for the diagnosis and treatment of clinical bloodstream infections.
      Methods  Bruker Corporation’s matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used for bacterial identification, VITEK 2 Compact was used for antimicrobial susceptibility test, some of which was done with the Kirby-Bauer method, and the data was statistically analyzed with WHONET 5.6 software.
      Results  A total of 8931 bacterial strains, including 4502 (50.4%) Gram-positive bacteria and 4429 (49.6%) Gram-negative bacteria, were isolated from the blood samples between 2016 and 2020. Among the isolated bacteria of the order Enterobacterales, Escherichia coli (1773, 19.9%) ranked first, followed by Klebsiella pneumoniae (1067, 11.9%). The non-fermenting bacteria identified were predominantly Acinetobacter baumannii (293, 3.3%) and Pseudomonas aeruginosa (238, 2.7%). The top three Staphylococcus species were Staphylococcus epidermidis (970 strains, 10.9%), Staphylococcus hominis (713, 8.0%) and Staphylococcus aureus (541, 6.1%). Escherichia coli showed high in vitro susceptibility to cefoperazone/sulbactam, amikacin, polymyxin B, tigecycline, and carbapenems, and the sensitivity rate was consistently over 90%. The resistance rate to imipenem showed a trend of slow growth, and the resistance rate of meropenem was 2.2% to 3.4%. Klebsiella pneumoniae showed higher in vitro resistance rate to common antibiotics than that of Escherichia coli, with only the sensitivity rates to tigecycline and polymyxin B being higher than 90%, and the resistance rate to imipenem and meropenem increasing year by year. The resistance rate of Pseudomonas aeruginosa to imipenem decreased since 2017 (from 25.6% to18.6%), and the resistance rate of Acinetobacter baumannii to imipenem and meropenem were 73.7%-91.3% and 73.0%-91.3%. Staphylococcus resistant to vancomycin or linezolid was not found. Enterococci showed rather low resistance to vancomycin and linezolid.
      Conclusion   The distribution of common species of pathogenic bacteria in clinical blood samples in our hospital did not show significant changes, but the problem of multi-drug resistant bacteria is becoming increasingly more serious, especially so for carbapenem-resistant Klebsiella pneumoniae.

     

  • 血流感染是由各种病原菌和/或毒素侵入血液所引起的全身感染性疾病,且有逐年增长的趋势,尤其是多重耐药性细菌如碳青霉烯类耐药革兰阴性杆菌引起的血流感染,病死率高,患者负担重。血培养阳性是血流感染的金标准,为及时掌握本院血液标本病原菌菌种分布和菌株耐药情况,动态监测具有十分重要的意义。我们回顾性分析了本院2016−2020年间血液标本来源的病原菌分布和耐药性变化,为临床血流感染诊治提供依据。

    2016−2020年四川大学华西医院门诊及住院患者血液标本来源分离细菌,剔除相同患者同分离的相同菌株。本研究经四川大学华西医院生物医学伦理审查委员会批准(2021年审623号)。

    药敏试验用Mueller-Hinton琼脂平皿,肺炎链球菌及各组链球菌用含5%绵羊血琼脂平皿,流感嗜血杆菌用HTM平皿;血培养瓶(法国生物梅里埃公司),全自动血培养仪报阳后按照血培养瓶类型转种平皿,需氧血培养瓶转种5%绵羊血琼脂平皿和普通巧克力琼脂平皿(未加抗生素),厌氧血培养瓶在需氧血培养瓶转种方案上增加厌氧血平皿。以上平皿除厌氧血平皿由重庆庞通医疗器械有限公司生产外,其余均为郑州安图生物股份有限公司生产。

    BACT/ALERT 3D全自动血培养仪(法国生物梅里埃公司),全自动生化鉴定及药敏系统(Vitek 2 Compact,法国生物梅里埃公司),基质辅助激光解吸电离飞行时间质谱(matrix-assisted laser desorption ionization time-of-flight mass spectrometry, MALDI-TOF MS,德国Bruker Corporation), 35 ℃电热恒温培养箱(四川浩洋医疗器械有限公司),CO2培养箱(赛默飞世尔科技有限公司)。

    全自动生化鉴定和药敏卡(GN, GP, GN67, XNO4, GP67, GP68)为法国生物梅里埃公司产品,抗菌药物纸片为Oxoid公司产品,E-test条为郑州安图生物公司产品,包括青霉素、红霉素、克林霉素、庆大霉素、利福平、甲氧苄啶/磺胺甲噁唑、利奈唑胺、万古霉素、左氧氟沙星、环丙沙星、氨苄西林、头孢他啶、头孢曲松、头孢噻肟、头孢吡肟、亚胺培南、美罗培南、厄他培南、阿米卡星等,微量肉汤稀释法为温州康泰生物科技有限公司产品,包括多粘菌素B、替加环素。

    MALDI-TOF MS进行鉴定且分值≥2.0;采用改良直接涂布法,挑取单个待检菌落涂布靶板,滴加1 μL 70%甲酸,自然干燥后再滴加1 μL基质液即可。

    多数药敏试验上自动化药敏测定系统(Vitek 2 Compact)及配套的药敏卡,部分试验采用纸片扩散法(Kirby-Bauer, KB),对于少见耐药或罕见耐药表型或矛盾耐药表型时采用E-test条或微量肉汤稀释法复检。质控菌株按照CLSI要求,为金黄色葡萄球菌ATCC 25923、金黄色葡萄球菌ATCC 29213、大肠埃希菌ATCC 25922、大肠埃希菌ATCC 35218、肺炎克雷伯菌ATCC 700603、铜绿假单胞菌 ATCC 27853、流感嗜血杆菌 ATCC 49247、肺炎链球菌 ATCC 49619等。

    监测耐药菌株检出和分布情况、不同菌株对不同抗菌药的耐药性情况。

    全年耐药菌数据分析用WHONET 5.6软件。

    2016−2020年血液标本来源分离菌株共8931株,其中革兰阳性菌4502株(50.4%),革兰阴性菌4429株(49.6%)。病原菌分离率居首位的是大肠埃希菌(1773株,19.9%),其次是肺炎克雷伯菌(1067株,11.9%)、表皮葡萄球菌(970株,10.9%)、人葡萄球菌(713株,8.0%)、金黄色葡萄球菌(541株,6.1%)、屎肠球菌(448株,5.0%)、鲍曼不动杆菌(293株,3.3%)、铜绿假单胞菌(238株,2.7%)、阴沟肠杆菌(208株,2.3%)、粪肠球菌(195株,2.2%),每年血液标本分离率前10位的细菌见表1。细菌分离数前10位的科室分别是急诊科(2726株)、ICU(889株)、中西医结合科(396株)、消化内科(349株)、肾脏内科(346株)、神经外科(336株)、血液内科(334株)、感染科(275株)、眼科(249株)、呼吸内科(243株),血液标本分离细菌数大于100株的科室分布见图1

    表  1  2016−2020年血液标本来源分离细菌前10位菌种分布
    Table  1.  The distribution of the top 10 strains of bacteria isolated from blood samples from 2016 to 2020
    Rank2016 (n=1471)2017 (n=1780)2018 (n=1849)2019 (n=1912)2020 (n=1962)
    1 Escherichia coli
    (350, 23.8%)
    Escherichia coli
    (328, 18.4%)
    Escherichia coli
    (361, 19.5%)
    Escherichia coli
    (370, 19.4%)
    Escherichia coli
    (383, 19.5%)
    2 Staphylococcus epidermidis
    (172, 11.7%)
    Klebsiella pneumoniae
    (224, 12.6%)
    Klebsiella pneumoniae
    (242, 13.1%)
    Staphylococcus epidermidis
    (218, 11.4%)
    Klebsiella pneumoniae
    (243, 12.4%)
    3 Klebsiella pneumoniae
    (150, 10.2%)
    Staphylococcus epidermidis
    (173, 9.7%)
    Staphylococcus epidermidis
    (198, 10.7%)
    Klebsiella pneumoniae
    (212, 11.1%)
    Staphylococcus epidermidis
    (212, 10.8%)
    4 Staphylococcus hominis
    (117, 8.0%)
    Staphylococcus hominis
    (132, 7.4%)
    Staphylococcus hominis
    (119, 6.4%)
    Enterococcus faecium
    (118, 6.2%)
    Staphylococcus hominis
    (136, 6.9%)
    5 Staphylococcus aureus
    (95, 6.5%)
    Staphylococcus aureus
    (114, 6.4%)
    Staphylococcus aureu
    (105, 5.7%)
    Staphylococcus aureus
    (117, 6.1%)
    Staphylococcus aureus
    (115, 5.9%)
    6 Enterococcus faecium
    (87, 5.9%)
    Enterococcus faecium
    (72, 4.0%)
    Enterococcus faecium
    (94, 5.1%)
    Staphylococcus hominis
    (110, 5.8%)
    Enterococcus faecium
    (81, 4.1%)
    7 Staphylococcus haemolyticus
    (49, 3.3%)
    Pseudomonas aeruginosa
    (60, 3.4%)
    Pseudomonas aeruginosa
    (56, 3.0%)
    Acinetobacter baumannii
    (63, 3.3%)
    Staphylococcus capitis
    (49, 2.5%)
    8 Pseudomonas aeruginosa
    (36, 2.4%)
    Acinetobacter baumannii
    (59, 3.3%)
    Acinetobacter baumannii
    (56, 3.0%)
    Enterobacter cloacae
    (63, 3.3%)
    Pseudomonas aeruginosa
    (47, 2.4%)
    9 Acinetobacter baumannii
    (35, 2.4%)
    Enterobacter cloacae
    (54, 3.0%)
    Staphylococcus capitis ss. Ureolyticus
    (39, 2.1%)
    Enterococcus faecalis
    (45, 2.4%)
    Staphylococcus haemolyticus
    (46, 2.3%)
    10 Staphylococcus capitis
    (30, 2.0%)
    Enterococcus faecalis
    (39, 2.2%)
    Enterococcus faecalis
    (38, 2.1%)
    Pseudomonas aeruginosa
    (40, 2.1%)
    Enterococcus faecalis
    (45, 2.3%)
    下载: 导出CSV 
    | 显示表格
    图  1  血液标本分离细菌数大于100株的科室分布
    Figure  1.  The distribution of departments with more than 100 strains of bacteria isolated from blood samples
    ICU: Intensive care unit; TCM&WM: Department of integrated traditional chinese and western medicine.

    血培养分离的大肠埃希菌对头孢哌酮/舒巴坦、阿米卡星、多粘菌素B、替加环素及碳青霉烯类药敏的体外敏感性较高,均在90%以上,对亚胺培南的耐药率有缓慢上升的趋势,美罗培南的耐药率为2.2%~3.4%,未检出对多粘菌素B的耐药株。肺炎克雷伯菌对常见抗生素体外耐药率高于大肠埃希菌,仅替加环素和多粘菌素B的耐药率低于10%,亚胺培南和美罗培南的耐药率逐年升高,2020年肺炎克雷伯菌对亚胺培南和美罗培南的耐药率均高于30%(31.0%和31.5%)。血培养分离的铜绿假单胞菌自2017年起对亚胺培南耐药率有下降(25.6%~18.6%),对B-内酰胺类复合制剂的敏感率也有所升高,对阿米卡星的耐药率从11.8%降至2.3%,未发现多粘菌素B耐药株。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率为73.7%~91.3%和73.0%~91.3%,对头孢哌酮/舒巴坦的耐药率为17.0%~49.0%,替加环素敏感率高于90%,无多粘菌素B耐药株。见表2表5

    表  2  2016−2020年大肠埃希菌对抗菌药物的药敏结果
    Table  2.  Antimicrobial susceptibility results of Escherichia coli from 2016 to 2020
    Drug20162017201820192020
    nR/%nR/%nR/%nR/%nR/%
    Ampicillin 333 91.0 320 90.9 360 91.4 359 88.8 373 91.4
    Piperacillin 297 82.7 360 82.8 359 78.8 363 81.5
    Ciprofloxacin 333 58.9 320 63.0 360 61.0 359 56.5 365 63.6
    Cefotaxime 297 56.3 360 60.1 359 54.4 365 60.3
    Cefuroxime 297 56.3 360 60.1 328 54.4 365 60.7
    Trimethoprim/Sulfamethoxazole 330 51.2 320 54.8 360 61.8 329 56.6 373 52.5
    Levofloxacin 330 49.8 320 53.8 360 56.9 329 52.6 363 57.2
    Ampicillin/Sulbactam 296 50.5 360 60.3 330 54.5 364 36.3
    Gentamicin 333 41.7 320 42.2 360 42.7 329 35.0 373 32.0
    Cefepime 333 16.8 320 17.8 360 21.0 330 13.6 265 15.8
    Ceftazidime 287 24.7 360 26.0 330 29.4 365 26.9
    Cefoxitin 319 18.8 234 11.8
    Cefoperazone/Sulbactam 152 8.6 210 8.1 239 6.7 317 4.7 308 5.2
    Piperacillin/Tazobactam 332 6.6 320 17.0 346 19.3 327 13.8 363 14.4
    Amikacin 333 3.3 292 4.4 346 4.5 329 5.2 373 5.3
    Meropenem 295 2.2 360 3.4 360 2.5 364 2.7
    Imipenem 329 0.9 292 2.1 360 3.4 360 2.4 365 2.7
    Polymyxin B 131 0.0 192 0.0 238 0.0 294 0.0 282 0.0
    Tigecycline 314 0.3 231 0.0 290 0.0 310 0.0 337 0.0
     −: Undetected; R: Drug resistance rate.
    下载: 导出CSV 
    | 显示表格
    表  3  2016−2020年肺炎克雷伯菌对抗菌药物的药敏结果
    Table  3.  Antimicrobial susceptibility results of Klebsiella pneumoniae from 2016 to 2020
    Drug20162017201820192020
    nR/%nR/%nR/%nR/%nR/%
    Cefotaxime 123 52.8 189 43.4 154 46.1 215 52.1
    Piperacillin 123 57.7 189 49.7 195 52.3 215 55.8
    Ampicillin/Sulbactam 121 56.2 189 47.1 195 52.8 217 54.8
    Cefuroxime 122 56.6 188 45.2 194 49.5 217 53.5
    Ceftazidime 138 27.5 114 45.6 189 33.3 192 40.1 215 38.1
    Ciprofloxacin 138 29.0 153 45.1 189 49.2 193 47.2 216 49.1
    Trimethoprim/Sulfamethoxazole 135 22.2 153 41.8 188 35.1 188 33.0 210 33.8
    Cefepime 138 14.5 154 33.1 187 27.8 191 33.5 217 35.5
    Cefoxitin 133 18.8 32 18.8
    Levofloxacin 138 20.3 153 39.9 189 38.1 195 41.5 214 39.3
    Gentamicin 138 15.2 152 27.6 189 30.2 195 35.9 215 34.4
    Piperacillin/Tazobactam 135 17.0 154 41.6 185 34.6 191 44.0 215 41.9
    Cefoperazone/Sulbactam 65 20.0 135 31.9 170 29.4 180 31.7 196 34.2
    Meropenem 109 17.4 187 23.5 192 27.6 213 31.5
    Imipenem 137 5.8 141 19.1 186 23.1 191 27.2 213 31.0
    Ertapenem 149 25.5 186 24.7 190 28.4 200 27.5
    Amikacin 138 2.9 151 15.2 187 18.7 192 18.2 215 22.3
    Tigecycline 131 7.6 143 1.4 156 1.8 112 0.0 210 1.0
    Polymyxin B 54 0.0 123 0.0 168 0.0 160 0.0 193 0.5
     −: Undetected; R: Drug resistance rate.
    下载: 导出CSV 
    | 显示表格
    表  4  2016−2020年铜绿假单胞菌对抗菌药物的药敏结果
    Table  4.  Antimicrobial susceptibility results of Pseudomonas aeruginosa from 2016 to 2020
    Drug2016 2017 2018 2019 2020
    nR/%nR/%nR/%nR/%nR/%
    Ticarcillin/Clavulanate 36 30.6 39 20.5 36 27.8 44 18.2
    Imipenem 32 18.8 39 25.6 37 24.3 35 20.0 43 18.6
    Aztreonam 32 21.9 39 28.2 39 10.3 36 13.9 44 6.8
    Meropenem 33 18.2 36 16.7 36 19.4 43 18.6
    Piperacillin 36 27.8 38 10.5 36 25.0 44 11.4
    Ceftazidime 34 17.6 38 7.9 36 22.2 44 9.1
    Levofloxacin 33 30.3 39 17.9 39 7.7 36 16.7 44 6.8
    Cefoperazone/Sulbactam 20 25.0 38 18.4 36 2.8 36 8.3 41 4.9
    Piperacillin/Tazobactam 33 12.1 41 22.0 38 15.8 36 19.4 44 18.2
    Ciprofloxacin 33 30.3 40 20.0 39 2.6 36 19.4 44 4.5
    Cefepime 34 20.6 41 22.0 39 5.1 36 11.1 44 2.3
    Gentamicin 33 15.2 41 7.3 39 2.6 36 11.1 44 2.3
    Amikacin 34 11.8 40 7.5 39 2.6 36 2.8 44 2.3
    Polymyxin B 17 0.0 32 0.0 34 0.0 32 0.0 36 0.0
     −: Undetected; R: Drug resistance rate.
    下载: 导出CSV 
    | 显示表格
    表  5  2016−2020年鲍曼不动杆菌对抗菌药物的药敏结果
    Table  5.  Antimicrobial susceptibility results of Acinetobacter baumannii from 2016 to 2020
    Drug20162017201820192020
    nR/%nR/%nR/%nR/%nR/%
    Piperacillin 38 88.0 38 76.3 52 86.5 23 95.7
    Piperacillin/Tazobactam 27 83.6 50 86.8 38 76.3 52 84.6 23 91.3
    Meropenem 57 86.5 37 73.0 52 84.6 23 91.3
    Ciprofloxacin 28 88.2 50 88.0 39 74.4 52 84.6 23 95.7
    Imipenem 28 88.2 50 86.0 38 73.7 52 84.6 23 91.3
    Ceftazidime 35 85.7 38 73.7 52 86.5 23 91.3
    Gentamicin 28 75.0 50 84.0 39 71.8 52 80.8 23 82.6
    Cefepime 28 88.2 50 88.0 39 74.4 52 84.6 23 91.3
    Ampicillin/Sulbactam 37 81.1 38 71.1 52 73.1 23 82.6
    Levofloxacin 28 41.2 46 80.4 39 74.4 51 80.4 23 91.3
    Trimethoprim/Sulfamethoxazole 23 61.9 38 76.3 32 62.5 45 66.7 18 72.2
    Amikacin 27 14.0 42 55.6 38 40.7 49 57.1 22 46.2
    Cefoperazone/Sulbactam 21 49.0 47 17.0 36 27.8 50 22.0 23 21.7
    Tigecycline 25 0.0 48 4.2 38 7.9 52 1.9 23 0.0
    Polymyxin B 28 0.0 43 0.0 35 0.0 50 0.0 23 0.0
     −: Undetected; R: Drug resistance rate.
    下载: 导出CSV 
    | 显示表格

    1784株凝固酶阴性葡萄球菌(coagulase-negative Staphylococcus, CNS)中甲氧西林耐药的凝固酶阴性葡萄球菌(MRCNS)有1409株(79.0%),对青霉素G、苯唑西林、红霉素及克林霉素的耐药率分别为78.8%、79.0%、81.3%和36.7%,未发现有对万古霉素、利奈唑胺耐药的菌株。546株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)有154株(28.2%),5年间MRSA的分离率有波动,2016年26.7%(24/90)、2017年24.4%(19/78)、2018年20.5%(16/78)、2019年33.0%(34/103)、2020年36.2%(38/105),红霉素和克林霉素的耐药率随MRSA的检出数呈波动变化,未发现万古霉素和利奈唑胺耐药株。屎肠球菌万古霉素和利奈唑胺的耐药率为0.0%~3.7%和0.0%~1.3%。见表6表8

    表  6  2016−2020年凝固酶阴性葡萄球菌对抗菌药物的药敏结果
    Table  6.  Antimicrobial susceptibility results of coagulase-negative Staphylococcus from 2016 to 2020
    Drug2016 2017 2018 2019 2020
    nR/%nR/%nR/%nR/%nR/%
    Penicillin G 302 83.1 276 80.8 323 78.3 377 77.7 408 74.0
    Oxacillin 300 83.7 276 80.8 324 78.1 378 78.0 407 74.2
    Gentamicin 302 21.5 279 18.3 326 18.1 379 16.9 408 12.3
    Rifampicin 301 19.6 278 16.5 325 13.2 379 14.2 407 10.6
    Levofloxacin 302 56.0 279 54.8 325 53.2 379 57.5 406 52.5
    Trimethoprim/Sulfamethoxazole 220 52.7 279 50.5 325 48.9 379 49.1 407 42.5
    Clindamycin 301 38.9 277 36.5 324 39.8 377 37.4 408 30.9
    Erythromycin 302 85.1 278 80.6 326 81.0 379 81.5 408 78.2
    Linezolid 297 0 274 0.0 327 0 376 0.0 409 0.0
    Vancomycin 301 0 273 0.0 319 0.0 379 0.0 408 0.0
     R: Drug resistance rate.
    下载: 导出CSV 
    | 显示表格
    表  7  2016−2020年金黄色葡萄球菌对抗菌药物的药敏结果
    Table  7.  Antimicrobial susceptibility results of Staphylococcus aureus from 2016 to 2020
    Drug2016 2017 2018 2019 2020
    nR/%nR/%nR/%nR/%nR/%
    Penicillin G 91 91.2 79 89.9 78 89.7 101 93.1 103 89.3
    Oxacillin 90 26.7 78 24.4 78 20.5 103 33.0 105 36.2
    Gentamicin 91 17.6 79 15.2 78 15.4 103 10.7 104 16.3
    Rifampicin 91 5.5 78 5.1 80 2.5 103 4.9 104 7.7
    Levofloxacin 91 19.8 79 13.9 80 13.8 103 16.5 104 17.3
    Trimethoprim/Sulfamethoxazole 87 16.1 78 21.8 80 21.2 103 9.7 105 16.2
    Clindamycin 91 36.3 78 34.6 80 36.2 103 29.1 104 45.2
    Erythromycin 90 58.9 79 49.4 80 51.2 103 50.5 104 64.4
    Linezolid 91 0.0 79 0.0 80 0.0 103 0.0 105 0.0
    Vancomycin 91 0.0 78 0.0 79 0.0 103 0.0 104 0.0
     R: Drug resistance rate.
    下载: 导出CSV 
    | 显示表格
    表  8  2016−2020年屎肠球菌对抗菌药物的药敏结果
    Table  8.  Antimicrobial susceptibility results of Enterococcus faecium from 2016 to 2020
    Drug2016 2017 2018 2019 2020
    nR/%nR/%nR/%nR/%nR/%
    Ampicillin 82 91.5 44 90.9 78 93.6 104 89.4 94.7 0.0
    High concentration of gentamicin 82 0.0 44 0.0 78 0.0 102 0.0 0 0.0
    High concentration of streptomycin 82 0.0 44 0.0 78 0.0 103 0.0 0 0.0
    Ciprofloxacin 82 92.7 44 90.9 52 92.3 104 85.6 93.3 2.7
    Levofloxacin 82 91.5 44 90.9 52 88.5 104 82.7 93.3 1.3
    Linezolid 79 0.0 44 0.0 77 1.3 103 0.0 75 1.3
    Vancomycin 82 3.7 43 7.0 77 2.6 104 1.0 75 0.0
     R: Drug resistance rate.
    下载: 导出CSV 
    | 显示表格

    图2可见,2016−2020年血培养主要多重耐药菌中MRSA和碳青霉烯耐药鲍曼不动杆菌(CRAB)自2018年起分离率有所上升(20.5%~36.2%和73.7%~91.3%),碳青霉烯耐药大肠埃希菌(CREC)和碳青霉烯耐药铜绿假单胞菌(CRPA)从2018年起有下降(3.4%~2.7%和24.3%~18.6%),万古霉素耐药的肠球菌(VRE)分离率逐年下降(3.4%~0.0%),而碳青霉烯耐药肺炎克雷伯菌(CRKP)上升趋势明显,2020年的耐药率已高于30.0%。

    图  2  2016−2020年主要多重耐药菌分离情况
    Figure  2.  The isolation of main multi-drug resistant bacteria from 2016 to 2020
    MRSA: Methicillin resistant Staphylococcus aureus; VRE: Vancomycin-resistant Enterococcus; CREC: Carbapenem-resistant Escherichia coli; CRAB: Carbapenem-resistant Acinetobacter baumannii; CRKP: Carbapenem-resistant Klebsiella pneumoniae; CRPA: Carbapenem-resistant Pseudomonas aeruginosa.

    血液感染病死率高,患者负担重,是目前临床面临的一个相当棘手的问题。本研究结果显示,回顾性分析本院2016−2020年血液标本来源分离病原菌8931株,其中革兰阳性菌4502株(50.4%),革兰阴性菌4429株(49.6%),革兰阳性菌分离率高于革兰阴性菌,与全国阴阳性菌分布有所差异[1]。病原菌菌种构成前5位无明显改变,分别是大肠埃希菌、肺炎克雷伯菌、表皮葡萄球菌、人葡萄球菌和金黄色葡萄球菌,与SENTRY耐药监测数据有所不同[2]

    革兰阳性菌中葡萄球菌是血液来源病原菌的常见菌种,凝固酶阴性葡萄球菌(CNS)以表皮葡萄球菌和人葡萄球菌为主要分离菌,占18.9%,是机会致病菌,也是血培养中常见的污染菌,意义尚不明确,若血培养中分离到CNS,仍需结合患者的临床表现、危险因素、报阳时间和次数等综合判断是否感染菌[3-4]。根据《血液培养技术用于血流感染诊断临床实践专家共识》[5]中对血培养污染菌的定义以及计算方法,本院2016−2020年污染率分别为1.9%、1.7%、1.8%、1.9%和1.8%。实验室仅能通过血培养送检套数以及报阳时间初步判断,提示临床疑似污染菌的可能。CNS等皮肤定植菌是致病菌还是污染菌仍需临床综合评估,但标准的血培养采集规范能给予临床更加准确可靠的血培养报告结果,包括采集指征、采集时机、血培养瓶的种类及采集套数、采集量、采集方式等[6]。金黄色葡萄球菌5年内分离541株,占6.1%,MRSA占金黄色葡萄球菌分离株总数的28.2%,与国内其他研究差异不大[7-8],未发现对万古霉素和利奈唑胺耐药的金黄色葡萄球菌,对于重症患者可作为其首选抗生素。2016−2020年万古霉素耐药屎肠球菌(vancomycin-resistant Enterococcus faecium, VREfm)平均检出率为2.9%,略高于全国平均水平[1],基因型均为Van A型,由此可见VRE耐药形势仍然不容乐观,临床及院感防控需采取相关措施进行控制其产生和传播。对利奈唑胺保持高度敏感性,平均耐药率为0.5%。

    革兰阴性菌中肠杆菌目细菌以大肠埃希菌居首位,占19.9%,其次是肺炎克雷伯菌11.9%,大肠埃希菌对头孢他啶、头孢吡肟、阿米卡星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦体外有较高的活性,耐药率均低于30%,对碳青霉烯类药物亚胺培南和美罗培南的耐药率为0~3.4%,未检出多粘菌素B耐药的大肠埃希菌。2016−2020年肺炎克雷伯菌对亚胺培南的耐药率逐年增长,5.8%~31.0%,碳青霉烯类药物是治疗产超广谱β-内酰胺酶多重耐药阴性菌的首选药物,碳青霉烯类耐药肠杆菌目细菌(carbapenem-resistant Enterobacteriaceae, CRE)的上升可能与其在临床的广泛使用有关[9],且易水平传播[10-11],若实验室分离该种细菌,应立即通知临床并上报医院感染管理部门采取感控措施[12]。碳青霉烯酶主要包括KPC、IMP、NDM、VIM等,我国肺炎克雷伯菌的主要流行基因型是KPC-2,其次是NDM型[13],不同基因型在临床治疗方案有所不同[14-15],如果CRE检出率高于15%,推荐检测碳青霉烯的酶型或基因型[16]。对于CRE的治疗多以替加环素和/或多粘菌素以及联合治疗为优选方案[17],头孢他啶/阿维巴坦是一种不具有β内酰胺结构的新型β内酰胺酶抑制剂[18-19],亦可用于KPC酶型的CRE,虽然目前暂未对头孢他啶/阿维巴坦进行常规药敏检测,本研究也未列出其药敏结果,但必要时可以根据我国主要的流行基因型选择该药治疗,也有多篇研究表明与传统酶抑制剂相比,阿维巴坦可显著抑制KPC酶活性[20-22]

    2016−2020年血液样本来源病原菌中的非发酵菌以鲍曼不动杆菌和铜绿假单胞菌为主,铜绿假单胞菌对抗菌药物的敏感性明显优于鲍曼不动杆菌,鲍曼不动杆菌对碳青霉烯类的亚胺培南和美罗培南的耐药率均在80%以上,同时对其他β内酰胺类药物敏感性低,对左氧氟沙星的耐药率也逐年上升,仅对多粘菌素B和替加环素有较高的敏感性。铜绿假单胞菌对亚胺培南的耐药率有所下降,但随着碳青霉烯类药物使用增加,碳青霉烯类异质性耐药铜绿假单胞菌的检出率也日益增加导致临床治疗失败[23]。另外铜绿假单胞菌毒力大,药敏变化较快及易形成生物膜,其引起血流感染的进展速度快、病死率高以及患者预后差[24-25]。本研究中238例铜绿假单胞菌引起的血流感染患者中,死亡21例,因病情较重而放弃治疗者47例,转院无法追踪10例,好转160例,好转率仅为67.2%。

    综上所述,本院2016−2020年血液样本来源的病原菌菌种分布并无明显的改变,大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌和铜绿假单胞菌仍然是血流感染患者常见的致病菌。本研究纳入的细菌共8931株,其中一部分是感染致病菌,一部分是条件致病菌,对于手术后感染患者或者免疫力低下的患者,条件致病菌仍然可以致病。凝固酶阴性葡萄球菌常定植在皮肤表面,可能由于采血不规范而引入污染菌,但其分离率占葡萄球菌属第一位,临床在排除污染菌的同时也需引起重视。另外多重耐药菌的耐药形势日趋严峻,特别是耐药性能水平转移的细菌,实验室要持续做好耐药监测工作,定期反馈耐药数据,为临床合理使用抗生素提供依据,也帮助医院感控部门加强院感防控,减缓耐药菌的产生,防止耐药菌的流行和传播。

    *    *    *

    利益冲突 所有作者均声明不存在利益冲突

  • 图  1   血液标本分离细菌数大于100株的科室分布

    Figure  1.   The distribution of departments with more than 100 strains of bacteria isolated from blood samples

    ICU: Intensive care unit; TCM&WM: Department of integrated traditional chinese and western medicine.

    图  2   2016−2020年主要多重耐药菌分离情况

    Figure  2.   The isolation of main multi-drug resistant bacteria from 2016 to 2020

    MRSA: Methicillin resistant Staphylococcus aureus; VRE: Vancomycin-resistant Enterococcus; CREC: Carbapenem-resistant Escherichia coli; CRAB: Carbapenem-resistant Acinetobacter baumannii; CRKP: Carbapenem-resistant Klebsiella pneumoniae; CRPA: Carbapenem-resistant Pseudomonas aeruginosa.

    表  1   2016−2020年血液标本来源分离细菌前10位菌种分布

    Table  1   The distribution of the top 10 strains of bacteria isolated from blood samples from 2016 to 2020

    Rank2016 (n=1471)2017 (n=1780)2018 (n=1849)2019 (n=1912)2020 (n=1962)
    1 Escherichia coli
    (350, 23.8%)
    Escherichia coli
    (328, 18.4%)
    Escherichia coli
    (361, 19.5%)
    Escherichia coli
    (370, 19.4%)
    Escherichia coli
    (383, 19.5%)
    2 Staphylococcus epidermidis
    (172, 11.7%)
    Klebsiella pneumoniae
    (224, 12.6%)
    Klebsiella pneumoniae
    (242, 13.1%)
    Staphylococcus epidermidis
    (218, 11.4%)
    Klebsiella pneumoniae
    (243, 12.4%)
    3 Klebsiella pneumoniae
    (150, 10.2%)
    Staphylococcus epidermidis
    (173, 9.7%)
    Staphylococcus epidermidis
    (198, 10.7%)
    Klebsiella pneumoniae
    (212, 11.1%)
    Staphylococcus epidermidis
    (212, 10.8%)
    4 Staphylococcus hominis
    (117, 8.0%)
    Staphylococcus hominis
    (132, 7.4%)
    Staphylococcus hominis
    (119, 6.4%)
    Enterococcus faecium
    (118, 6.2%)
    Staphylococcus hominis
    (136, 6.9%)
    5 Staphylococcus aureus
    (95, 6.5%)
    Staphylococcus aureus
    (114, 6.4%)
    Staphylococcus aureu
    (105, 5.7%)
    Staphylococcus aureus
    (117, 6.1%)
    Staphylococcus aureus
    (115, 5.9%)
    6 Enterococcus faecium
    (87, 5.9%)
    Enterococcus faecium
    (72, 4.0%)
    Enterococcus faecium
    (94, 5.1%)
    Staphylococcus hominis
    (110, 5.8%)
    Enterococcus faecium
    (81, 4.1%)
    7 Staphylococcus haemolyticus
    (49, 3.3%)
    Pseudomonas aeruginosa
    (60, 3.4%)
    Pseudomonas aeruginosa
    (56, 3.0%)
    Acinetobacter baumannii
    (63, 3.3%)
    Staphylococcus capitis
    (49, 2.5%)
    8 Pseudomonas aeruginosa
    (36, 2.4%)
    Acinetobacter baumannii
    (59, 3.3%)
    Acinetobacter baumannii
    (56, 3.0%)
    Enterobacter cloacae
    (63, 3.3%)
    Pseudomonas aeruginosa
    (47, 2.4%)
    9 Acinetobacter baumannii
    (35, 2.4%)
    Enterobacter cloacae
    (54, 3.0%)
    Staphylococcus capitis ss. Ureolyticus
    (39, 2.1%)
    Enterococcus faecalis
    (45, 2.4%)
    Staphylococcus haemolyticus
    (46, 2.3%)
    10 Staphylococcus capitis
    (30, 2.0%)
    Enterococcus faecalis
    (39, 2.2%)
    Enterococcus faecalis
    (38, 2.1%)
    Pseudomonas aeruginosa
    (40, 2.1%)
    Enterococcus faecalis
    (45, 2.3%)
    下载: 导出CSV

    表  2   2016−2020年大肠埃希菌对抗菌药物的药敏结果

    Table  2   Antimicrobial susceptibility results of Escherichia coli from 2016 to 2020

    Drug20162017201820192020
    nR/%nR/%nR/%nR/%nR/%
    Ampicillin 333 91.0 320 90.9 360 91.4 359 88.8 373 91.4
    Piperacillin 297 82.7 360 82.8 359 78.8 363 81.5
    Ciprofloxacin 333 58.9 320 63.0 360 61.0 359 56.5 365 63.6
    Cefotaxime 297 56.3 360 60.1 359 54.4 365 60.3
    Cefuroxime 297 56.3 360 60.1 328 54.4 365 60.7
    Trimethoprim/Sulfamethoxazole 330 51.2 320 54.8 360 61.8 329 56.6 373 52.5
    Levofloxacin 330 49.8 320 53.8 360 56.9 329 52.6 363 57.2
    Ampicillin/Sulbactam 296 50.5 360 60.3 330 54.5 364 36.3
    Gentamicin 333 41.7 320 42.2 360 42.7 329 35.0 373 32.0
    Cefepime 333 16.8 320 17.8 360 21.0 330 13.6 265 15.8
    Ceftazidime 287 24.7 360 26.0 330 29.4 365 26.9
    Cefoxitin 319 18.8 234 11.8
    Cefoperazone/Sulbactam 152 8.6 210 8.1 239 6.7 317 4.7 308 5.2
    Piperacillin/Tazobactam 332 6.6 320 17.0 346 19.3 327 13.8 363 14.4
    Amikacin 333 3.3 292 4.4 346 4.5 329 5.2 373 5.3
    Meropenem 295 2.2 360 3.4 360 2.5 364 2.7
    Imipenem 329 0.9 292 2.1 360 3.4 360 2.4 365 2.7
    Polymyxin B 131 0.0 192 0.0 238 0.0 294 0.0 282 0.0
    Tigecycline 314 0.3 231 0.0 290 0.0 310 0.0 337 0.0
     −: Undetected; R: Drug resistance rate.
    下载: 导出CSV

    表  3   2016−2020年肺炎克雷伯菌对抗菌药物的药敏结果

    Table  3   Antimicrobial susceptibility results of Klebsiella pneumoniae from 2016 to 2020

    Drug20162017201820192020
    nR/%nR/%nR/%nR/%nR/%
    Cefotaxime 123 52.8 189 43.4 154 46.1 215 52.1
    Piperacillin 123 57.7 189 49.7 195 52.3 215 55.8
    Ampicillin/Sulbactam 121 56.2 189 47.1 195 52.8 217 54.8
    Cefuroxime 122 56.6 188 45.2 194 49.5 217 53.5
    Ceftazidime 138 27.5 114 45.6 189 33.3 192 40.1 215 38.1
    Ciprofloxacin 138 29.0 153 45.1 189 49.2 193 47.2 216 49.1
    Trimethoprim/Sulfamethoxazole 135 22.2 153 41.8 188 35.1 188 33.0 210 33.8
    Cefepime 138 14.5 154 33.1 187 27.8 191 33.5 217 35.5
    Cefoxitin 133 18.8 32 18.8
    Levofloxacin 138 20.3 153 39.9 189 38.1 195 41.5 214 39.3
    Gentamicin 138 15.2 152 27.6 189 30.2 195 35.9 215 34.4
    Piperacillin/Tazobactam 135 17.0 154 41.6 185 34.6 191 44.0 215 41.9
    Cefoperazone/Sulbactam 65 20.0 135 31.9 170 29.4 180 31.7 196 34.2
    Meropenem 109 17.4 187 23.5 192 27.6 213 31.5
    Imipenem 137 5.8 141 19.1 186 23.1 191 27.2 213 31.0
    Ertapenem 149 25.5 186 24.7 190 28.4 200 27.5
    Amikacin 138 2.9 151 15.2 187 18.7 192 18.2 215 22.3
    Tigecycline 131 7.6 143 1.4 156 1.8 112 0.0 210 1.0
    Polymyxin B 54 0.0 123 0.0 168 0.0 160 0.0 193 0.5
     −: Undetected; R: Drug resistance rate.
    下载: 导出CSV

    表  4   2016−2020年铜绿假单胞菌对抗菌药物的药敏结果

    Table  4   Antimicrobial susceptibility results of Pseudomonas aeruginosa from 2016 to 2020

    Drug2016 2017 2018 2019 2020
    nR/%nR/%nR/%nR/%nR/%
    Ticarcillin/Clavulanate 36 30.6 39 20.5 36 27.8 44 18.2
    Imipenem 32 18.8 39 25.6 37 24.3 35 20.0 43 18.6
    Aztreonam 32 21.9 39 28.2 39 10.3 36 13.9 44 6.8
    Meropenem 33 18.2 36 16.7 36 19.4 43 18.6
    Piperacillin 36 27.8 38 10.5 36 25.0 44 11.4
    Ceftazidime 34 17.6 38 7.9 36 22.2 44 9.1
    Levofloxacin 33 30.3 39 17.9 39 7.7 36 16.7 44 6.8
    Cefoperazone/Sulbactam 20 25.0 38 18.4 36 2.8 36 8.3 41 4.9
    Piperacillin/Tazobactam 33 12.1 41 22.0 38 15.8 36 19.4 44 18.2
    Ciprofloxacin 33 30.3 40 20.0 39 2.6 36 19.4 44 4.5
    Cefepime 34 20.6 41 22.0 39 5.1 36 11.1 44 2.3
    Gentamicin 33 15.2 41 7.3 39 2.6 36 11.1 44 2.3
    Amikacin 34 11.8 40 7.5 39 2.6 36 2.8 44 2.3
    Polymyxin B 17 0.0 32 0.0 34 0.0 32 0.0 36 0.0
     −: Undetected; R: Drug resistance rate.
    下载: 导出CSV

    表  5   2016−2020年鲍曼不动杆菌对抗菌药物的药敏结果

    Table  5   Antimicrobial susceptibility results of Acinetobacter baumannii from 2016 to 2020

    Drug20162017201820192020
    nR/%nR/%nR/%nR/%nR/%
    Piperacillin 38 88.0 38 76.3 52 86.5 23 95.7
    Piperacillin/Tazobactam 27 83.6 50 86.8 38 76.3 52 84.6 23 91.3
    Meropenem 57 86.5 37 73.0 52 84.6 23 91.3
    Ciprofloxacin 28 88.2 50 88.0 39 74.4 52 84.6 23 95.7
    Imipenem 28 88.2 50 86.0 38 73.7 52 84.6 23 91.3
    Ceftazidime 35 85.7 38 73.7 52 86.5 23 91.3
    Gentamicin 28 75.0 50 84.0 39 71.8 52 80.8 23 82.6
    Cefepime 28 88.2 50 88.0 39 74.4 52 84.6 23 91.3
    Ampicillin/Sulbactam 37 81.1 38 71.1 52 73.1 23 82.6
    Levofloxacin 28 41.2 46 80.4 39 74.4 51 80.4 23 91.3
    Trimethoprim/Sulfamethoxazole 23 61.9 38 76.3 32 62.5 45 66.7 18 72.2
    Amikacin 27 14.0 42 55.6 38 40.7 49 57.1 22 46.2
    Cefoperazone/Sulbactam 21 49.0 47 17.0 36 27.8 50 22.0 23 21.7
    Tigecycline 25 0.0 48 4.2 38 7.9 52 1.9 23 0.0
    Polymyxin B 28 0.0 43 0.0 35 0.0 50 0.0 23 0.0
     −: Undetected; R: Drug resistance rate.
    下载: 导出CSV

    表  6   2016−2020年凝固酶阴性葡萄球菌对抗菌药物的药敏结果

    Table  6   Antimicrobial susceptibility results of coagulase-negative Staphylococcus from 2016 to 2020

    Drug2016 2017 2018 2019 2020
    nR/%nR/%nR/%nR/%nR/%
    Penicillin G 302 83.1 276 80.8 323 78.3 377 77.7 408 74.0
    Oxacillin 300 83.7 276 80.8 324 78.1 378 78.0 407 74.2
    Gentamicin 302 21.5 279 18.3 326 18.1 379 16.9 408 12.3
    Rifampicin 301 19.6 278 16.5 325 13.2 379 14.2 407 10.6
    Levofloxacin 302 56.0 279 54.8 325 53.2 379 57.5 406 52.5
    Trimethoprim/Sulfamethoxazole 220 52.7 279 50.5 325 48.9 379 49.1 407 42.5
    Clindamycin 301 38.9 277 36.5 324 39.8 377 37.4 408 30.9
    Erythromycin 302 85.1 278 80.6 326 81.0 379 81.5 408 78.2
    Linezolid 297 0 274 0.0 327 0 376 0.0 409 0.0
    Vancomycin 301 0 273 0.0 319 0.0 379 0.0 408 0.0
     R: Drug resistance rate.
    下载: 导出CSV

    表  7   2016−2020年金黄色葡萄球菌对抗菌药物的药敏结果

    Table  7   Antimicrobial susceptibility results of Staphylococcus aureus from 2016 to 2020

    Drug2016 2017 2018 2019 2020
    nR/%nR/%nR/%nR/%nR/%
    Penicillin G 91 91.2 79 89.9 78 89.7 101 93.1 103 89.3
    Oxacillin 90 26.7 78 24.4 78 20.5 103 33.0 105 36.2
    Gentamicin 91 17.6 79 15.2 78 15.4 103 10.7 104 16.3
    Rifampicin 91 5.5 78 5.1 80 2.5 103 4.9 104 7.7
    Levofloxacin 91 19.8 79 13.9 80 13.8 103 16.5 104 17.3
    Trimethoprim/Sulfamethoxazole 87 16.1 78 21.8 80 21.2 103 9.7 105 16.2
    Clindamycin 91 36.3 78 34.6 80 36.2 103 29.1 104 45.2
    Erythromycin 90 58.9 79 49.4 80 51.2 103 50.5 104 64.4
    Linezolid 91 0.0 79 0.0 80 0.0 103 0.0 105 0.0
    Vancomycin 91 0.0 78 0.0 79 0.0 103 0.0 104 0.0
     R: Drug resistance rate.
    下载: 导出CSV

    表  8   2016−2020年屎肠球菌对抗菌药物的药敏结果

    Table  8   Antimicrobial susceptibility results of Enterococcus faecium from 2016 to 2020

    Drug2016 2017 2018 2019 2020
    nR/%nR/%nR/%nR/%nR/%
    Ampicillin 82 91.5 44 90.9 78 93.6 104 89.4 94.7 0.0
    High concentration of gentamicin 82 0.0 44 0.0 78 0.0 102 0.0 0 0.0
    High concentration of streptomycin 82 0.0 44 0.0 78 0.0 103 0.0 0 0.0
    Ciprofloxacin 82 92.7 44 90.9 52 92.3 104 85.6 93.3 2.7
    Levofloxacin 82 91.5 44 90.9 52 88.5 104 82.7 93.3 1.3
    Linezolid 79 0.0 44 0.0 77 1.3 103 0.0 75 1.3
    Vancomycin 82 3.7 43 7.0 77 2.6 104 1.0 75 0.0
     R: Drug resistance rate.
    下载: 导出CSV
  • [1] 全国细菌耐药监测网. 全国细菌耐药监测网2014−2019年血标本病原菌耐药性变迁. 中国感染控制杂志,2021,20(2): 124–133. DOI: 10.12138/j.issn.1671-9638.20216173
    [2]

    DIEKEMA D J, HSUEH P, MENDES R E, et al. The microbiology of bloodstream infection: 20-year trends from the SENTRY antimicrobial surveillance program. Antimicrob Agents Chemother, 2019, 63(7): e00355-19[2021-07-06].https://doi.org/10.1128/AAC.00355-19.

    [3] 李治锋, 王珏, 刘根焰, 等. 血培养中鉴别凝固酶阴性葡萄球菌为致病菌回归模型的建立与临床评价. 检验医学,2017,32(3): 189–193.
    [4]

    OSAKI S, KIKUCHI K, MORITOKI Y, et al. Distinguishing coagulase-negative Staphylococcus bacteremia from contamination using blood-culture positive bottle detection pattern and time to positivity. J Infect Chemother,2020,26(7): 672–675. DOI: 10.1016/j.jiac.2020.02.004

    [5] 中国医疗保健国际交流促进会临床微生物与感染分会, 中华医学会检验医学分会临床微生物学组, 中华医学会微生物学和免疫学分会临床微生物学组. 血液培养技术用于血流感染诊断临床实践专家共识. 中华检验医学杂志,2022,45(2): 105–121. DOI: 10.3760/cma.j.cn114452-20211109-00695
    [6]

    DAWSON S. Blood culture contaminants. J Hosp Infect,2014,87(1): 1–10. DOI: 10.1016/j.jhin.2014.02.009

    [7] 李丽, 金力, 朱咏臻, 等. 2014−2019年某医院血流感染患者的临床特征和病原学分析. 中国抗生素杂志,2022,47(1): 84–89. DOI: 10.3969/j.issn.1001-8689.2022.01.012
    [8] 鲍金凤, 叶丽艳, 马雅婷, 等. 某三甲医院2018−2020年血流感染病原菌分布及其耐药性分析. 解放军医学院学报,2021,42(5): 525–532. DOI: 10.3969/j.issn.2095-5227.2021.05.010
    [9]

    GIROMETTI N, LEWIS R E, GIANNELLA M, et al. Klebsiella pneumoniae bloodstream infection: Epidemiology and impact of inappropriate empirical therapy. Medicine (Baltimore),2014,93(17): 298–309. DOI: 10.1097/MD.0000000000000111

    [10]

    YIGIT H, QUEENAN A M, ANDERSON G J, et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother,2001,45(4): 1151–1161. DOI: 10.1128/AAC.45.4.1151-1161.2001

    [11]

    SNITKIN E S, ZELAZNY A M, THOMAS P J, et al. Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing. Sci Transl Med,2012,4(148): 148ra116. DOI: 10.1126/scitranslmed.3004129

    [12]

    Guidelines for the Prevention and Control of Carbapenem-Resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in Health Care Facilities. Geneva: World Health Organization; 2017. https://www.ncbi.nlm.nih.gov/books/NBK493061/.

    [13]

    KARLOWSKY J A, LOB S H, KAZMIERCZAK K M, et al. In vitro activity of imipenem against carbapenemase-positive Enterobacteriaceae isolates collected by the SMART Global Surveillance Program from 2008 to 2014. J Clin Microbiol,2017,55(6): 1638–1649. DOI: 10.1128/JCM.02316-16

    [14] 张冀霞, 刘颖梅, 陈宏斌, 等. 我国产碳青霉烯酶肠杆菌科细菌的基因型及流行病学研究. 中华内科杂志,2014,53(2): 116–120. DOI: 10.3760/cma.j.issn.0578-1426.2014.02.010
    [15] 徐红云, 刘春林, 陈弟, 等. 2010−2016年耐碳青霉烯类肺炎克雷伯菌及大肠埃希菌临床分布及其耐药特征. 中国感染控制杂志,2018,17(8): 688–692. DOI: 10.3969/j.issn.1671-9638.2018.08.007
    [16] 中国医疗保健国际交流促进会临床微生物与感染分会, 中华医学会检验医学分会临床微生物学组, 中华医学会微生物学与免疫学分会临床微生物学组. 多黏菌素类与替加环素及头孢他啶/阿维巴坦药敏方法和报告专家共识. 中华检验医学杂志,2020,43(10): 964–972. DOI: 10.3760/cma.j.cn114452-20200719-00619
    [17]

    GUAN X, HE L, HU B, et al. Laboratory diagnosis, clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli: A Chinese consensus statement. Clin Microbiol Infect,2016,22 Suppl 1: S15–S25. DOI: 10.1016/j.cmi.2015.11.004

    [18]

    LAHIRI S D, MANGANI S, DURAND-REVILLE T, et al. Structural insight into potent broad-spectrum inhibition with reversible recyclization mechanism: Avibactam in complex with CTX-M-15 and Pseudomonas aeruginosa AmpC β-lactamases. Antimicrob Agents Chemother,2013,57(6): 2496–2505. DOI: 10.1128/AAC.02247-12

    [19]

    EHMANN D E, JAHIĆ H, ROSS P L, et al. Avibactam is a covalent, reversible, non-β-lactam β-lactamase inhibitor. Proc Natl Acad Sci U S A,2012,109(29): 11663–11668. DOI: 10.1073/pnas.1205073109

    [20]

    GOODLET K J, NICOLAU D P, NAILOR M D. Ceftolozane/tazobactam and ceftazidime/avibactam for the treatment of complicated intra-abdominal infections. Ther Clin Risk Manag,2016,12: 1811–1826. DOI: 10.2147/TCRM.S120811

    [21]

    LISCIO J L, MAHONEY M V, HIRSCH E B. Ceftolozane/tazobactam and ceftazidime/avibactam: Two novel β-lactam/β-lactamase inhibitor combination agents for the treatment of resistant Gram-negative bacterial infections. Int J Antimicrob Agents,2015,46(3): 266–271. DOI: 10.1016/j.ijantimicag.2015.05.003

    [22]

    BUSH K. A resurgence of β-lactamase inhibitor combinations effective against multidrug-resistant Gram-negative pathogens. Int J Antimicrob Agents,2015,46(5): 483–493. DOI: 10.1016/j.ijantimicag.2015.08.011

    [23] 刘宇阳, 陈茶, 黄彬. 铜绿假单胞菌对碳青霉烯类抗生素异质性耐药的研究进展. 中国感染控制杂志,2021,20(8): 763–768. DOI: 10.12138/j.issn.1671-9638.20217348
    [24] 熊玲玲, 马琼, 袁有华, 等. 铜绿假单胞菌血流感染57例的死亡危险因素分析. 中国感染与化疗杂志,2021,21(3): 254–257.
    [25] 王洪曼, 顾欣峰, 翟欣悦, 等. 铜绿假单胞菌生物膜及抗生物膜生成相关基因的研究进展. 临床合理用药杂志,2020,13(32): 178–181.
  • 期刊类型引用(3)

    1. 刘江龙,杨情远,袁军铭. 某院行消化内镜检查患者并发医院感染的影响因素分析. 抗感染药学. 2024(11): 1155-1158 . 百度学术
    2. 邱丽君,林璇,郭燕艺,陈东杰. 福建某院ICU与非ICU血培养主要革兰阴性菌耐药特征比较. 海峡预防医学杂志. 2023(01): 9-12 . 百度学术
    3. 陈卉,肖海娟. 甲氧西林耐药及敏感金黄色葡萄球菌快速鉴定中梅里埃VTIEK MS质谱仪的应用价值探究. 系统医学. 2023(05): 51-54+72 . 百度学术

    其他类型引用(1)

图(2)  /  表(8)
计量
  • 文章访问数:  862
  • HTML全文浏览量:  233
  • PDF下载量:  22
  • 被引次数: 4
出版历程
  • 收稿日期:  2021-08-08
  • 修回日期:  2022-04-14
  • 网络出版日期:  2022-07-21
  • 发布日期:  2022-07-19

目录

/

返回文章
返回