2021年中国老年人群感染病原菌分布和耐药性特征

唐思诗; 肖玉玲; 李静; 李冬冬; 吴思颖; 黄曦悦; 李金; 杨玲; 李进; 王瞳; 张戈; 徐英春; 谢轶

doi:10.12182/20240760303

摘要:

目的通过收集中国老年人群感染病原标准化病例数据，分析我国老年人群感染病原菌的分布及耐药性特征，完善中国感染病原菌规范化分层监测体系的建立。

方法收集2021年全国62家哨点医院老年感染人群（≥65岁）病例信息，从年龄、地区、病原菌分布及主要病原菌耐药性特征等方面进行分析。

结果 2021年共纳入全国老年人群感染病例3468例，患者来源前三的科室是重症医学科（13.2%）、呼吸内科（11.2%）和普通外科（8.4%）。标本类型以尿液（25.5%）、痰液（20.6%）和血液（18.7%）为主。分离病原菌3468株，革兰阴性菌占78.9%，革兰阳性菌占21.1%。病原菌主要由大肠埃希菌（20.9%）、肺炎克雷伯菌（18.3%）、铜绿假单胞菌（11.2%）、金黄色葡萄球菌（9.0%）和鲍曼不动杆菌（7.0%）构成。临床常见重要耐药菌分离率分别为：耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus, MRSA）38.0%，碳青霉烯类耐药鲍曼不动杆菌（carbapenem-resistant Acinetobacter baumannii, CRAB）68.7%，碳青霉烯类耐药铜绿假单胞菌（carbapenem-resistant Pseudomonas aeruginosa, CRPA）38.2%，碳青霉烯类耐药肺炎克雷伯菌（carbapenem-resistant Klebsiella pneumoniae, CRKP）20.1%，碳青霉烯类耐药大肠埃希菌（carbapenem-resistant Escherichia coli, CRECO）5.2%，耐万古霉素肠球菌（vancomycin-resistant Enterococcus, VRE）2.1%。全国七大区老年人群临床常见的重要耐药菌中CRAB和CRKP的分离率差异有统计学意义（P<0.05）。≥85岁的老年人群中肺炎克雷伯菌为最主要的病原菌，且CRKP的分离率在不同老年年龄段差异有统计学意义（P<0.05）。

结论全国不同地区及年龄段老年人群感染病原菌耐药性具有差异，监测老年人群感染病原菌分布及耐药性并根据地区及年龄层制定具有针对性的治疗方案，对提高老年人群疗效及改善预后具有重要意义。

Abstract:

Objective To study the distribution and drug resistance characteristics of pathogenic bacteria in the elderly population of China by collecting and analyzing the standardized case data on the pathogens of infections in elderly patients, and to facilitate the establishment of a standardized layered surveillance system for pathogenic bacteria in China.

Methods We collected the case data of elderly patients (≥65 years old) from 62 sentinel hospitals across the country in 2021. Then, we statistically analyzed the data by patient age, their geographical region, the distribution of pathogenic bacteria, and the drug resistance characteristics of main pathogens.

Results A total of 3468 cases from across the country were included in the study. The top three sources of patients were the intensive care unit (13.2%), the department of respiratory medicine (11.2%), and the department of general surgery (8.4%). The top three types of specimens were urine (25.5%), sputum (20.6%), and blood (18.7%). A total of 3468 strains of pathogens were isolated, among which, 78.9% were gram-negative bacteria and 21.1% were gram-positive bacteria. The top five types of bacteria were Escherichia coli (20.9%), Klebsiella pneumoniae (18.3%), Pseudomonas aeruginosa (11.2%), Staphylococcus aureus (9.0%), and Acinetobacter baumannii (7.0%). The isolation rates of common important drug-resistant bacteria were 38.0% for methicillin-resistant Staphylococcus aureus (MRSA), 68.7% for carbapenem-resistant Acinetobacter baumannii (CRAB), and 38.2% for carbapenem-resistant Pseudomonas aeruginosa (CRPA), 20.1% for carbapenem-resistant Klebsiella pneumoniae (CRKP), 5.2% for carbapenem-resistant Escherichia coli (CRECO), and 2.1% for vancomycin-resistant Enterococcus (VRE). There were differences in the isolation rates of CRAB and CRKP in clinical care in the elderly population in seven geographical regions of China (P<0.05). Klebsiella pneumoniae is the most important pathogen in the elderly population ≥85 years old, and the isolation rates of CRKP showed significant differences in different age groups (P<0.05).

Conclusion There are significant differences in the drug resistance of pathogenic bacteria in the elderly populations of different regions and age groups in China. Therefore, monitoring the distribution and drug resistance of pathogenic bacteria in the elderly population and formulating targeted treatment plans according to the characteristics of the specific regions and age groups are of great significance to the improvement in the treatment outcomes and prognosis of the elderly population.

2021年中国老年人群感染病原菌分布和耐药性特征

Distribution and Drug Resistance Characteristics of Pathogenic Bacteria in the Elderly Population in China in 2021