湖南省细菌耐药监测网2012—2021年胸、腹腔积液细菌耐药性监测报告

Antimicrobial resistance of bacteria from pleural and peritoneal effusion: surveillance report from Hunan Provincial Antimicrobial Resistance System, 2012-2021

摘要:

目的 了解湖南省胸、腹腔积液分离细菌的分布及耐药性变迁，为临床正确诊断及合理用药提供参考。 方法 收集湖南省细菌耐药监测网2012—2021年各成员单位上报数据，细菌耐药监测方法参照全国细菌耐药监测网（CARSS）技术方案执行，应用WHONET 5.6软件对胸、腹腔积液分离细菌及药敏结果数据进行分析。 结果 2012—2021年湖南省细菌耐药监测网成员单位胸、腹腔积液标本共分离细菌28 934株，其中胸腔积液分离菌株5 752株、腹腔积液分离23 182株。胸腔积液分离率居前5位的细菌依次为大肠埃希菌（907株，15.8%）、金黄色葡萄球菌（535株，9.3%）、肺炎克雷伯菌（369株，6.4%）、表皮葡萄球菌（452，7.9%）、溶血葡萄球菌（285株，5.0%）。胸腔积液耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为24.3%~39.2%，耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率为58.8%~77.1%。腹腔积液分离率居前5位的细菌依次为大肠埃希菌（8 264株，35.6%）、肺炎克雷伯菌（2 074株，9.0%）、屎肠球菌（1 458株，6.3%）、表皮葡萄球菌（1 383株，6.0%）、铜绿假单胞菌（1 152株，5.0%）。腹腔积液MRSA的检出率为22.1%~52.4%，且检出率呈下降趋势（P=0.004），MRCNS的检出率为60.4%~79.4%。腹腔积液中肠杆菌目细菌对头孢唑林、头孢呋辛、头孢曲松、头孢吡肟的耐药率均呈现下降趋势（均P < 0.05）。胸、腹腔积液中未发现对万古霉素、利奈唑胺和替考拉宁耐药的葡萄球菌，屎肠球菌对多数测试药物的耐药率高于粪肠球菌。肠杆菌目细菌对亚胺培南和美罗培南耐药率≤8.5%；非发酵革兰阴性杆菌对亚胺培南、美罗培南的耐药率≤43.3%。 结论 2012—2021年湖南省细菌耐药监测网胸、腹腔积液数据结构较完整，不同年份分离病原菌组成及药物敏感性不尽相同。

Abstract:

Objective To understand the distribution and antimicrobial resistance changes of bacteria isolated from pleural and peritoneal effusion in Hunan Province, and provide reference for correct clinical diagnosis and rational antimicrobial use. Methods Data reported by member units of Hunan Provincial Antimicrobial Resistance Survei-llance System from 2012 to 2021 were collected. Bacteria antimicrobial resistance surveillance method was implemented according to technical scheme of China Antimicrobial Resistance Surveillance System (CARSS), and WHONET 5.6 software was used to analyze the data of bacteria isolated from pleural and peritoneal effusion as well as antimicrobial susceptibility testing results. Results From 2012 to 2021, a total of 28 934 bacterial strains were isolated from specimens of pleural and peritoneal effusions from member units of Hunan Provincial Antimicrobial Resistance Surveillance System, with 5 752 strains from pleural effusion and 23 182 from peritoneal effusion. The top five bacteria isolated from pleural effusion were Escherichia coli (n=907, 15.8%), Staphylococcus aureus (n=535, 9.3%), Klebsiella pneumoniae (n=369, 6.4%), Staphylococcus epidermidis (n=452, 7.9%), and Staphylococcus haemolyticus (n=285, 5.0%). The detection rate of methicillin-resistant Staphylococcus aureus (MR-SA) from pleural effusion was 24.3%-39.2%, and that of methicillin-resistant coagulase negative Staphylococcus (MRCNS) was 58.8%-77.1%. The top five bacteria isolated from peritoneal effusion were Escherichia coli (n=8 264, 35.6%), Klebsiella pneumoniae (n=2 074, 9.0%), Enterococcus faecium (n=1 458, 6.3%), Staphylococcus epidermidis (n=1 383, 6.0%), and Pseudomonas aeruginosa (n=1 152, 5.0%). The detection rate of MRSA from peritoneal effusion was 22.1%-52.4%, which presented a decreasing trend (P=0.004). The detection rate of MRCNS was 60.4%-79.4%. The resistance rates of Enterobacterales from peritoneal effusion to cefazolin, cefuroxime, ceftriaxone and cefepime all showed decreasing trends (all P < 0.05). Vancomycin-, linezo-lid-, and teicoplanin-resistant Staphylococcus strains were not found in pleural and peritoneal effusions. The resis-tance rates of Enterococcus faecium to most tested antimicrobial agents were higher than those of Enterococcus faecalis. The resistance rates of Enterobacterales to imipenem and meropenem were ≤ 8.5%. The resistance rates of non-fermentative Gram-negative bacilli to imipenem and meropenem were ≤ 43.3%. Conclusion The data structure of Hunan Antimicrobial Resistance Surveillance System for pleural and peritoneal effusions from 2012 to 2021 is relatively complete. The constituent and antimicrobial susceptibility of isolated pathogenic bacteria vary in different years.