2019—2022年甘肃省ICU病原菌分布及耐药性

Distribution and antimicrobial resistance of pathogens from intensive care units in Gansu Province from 2019 to 2022

摘要:

目的 分析甘肃省重症监护病房(ICU)临床分离菌的分布及其耐药性，为该地区ICU患者合理使用抗菌药物提供依据。 方法 收集甘肃省细菌耐药监测网成员单位2019年1月—2022年12月各医院ICU临床分离菌的耐药监测资料，使用药敏纸片扩散法、最低抑菌浓度(MIC)法和E试验法测定细菌对抗菌药物敏感性，根据美国临床实验室标准化协会(CLSI)标准判读结果，采用WHONET 5.6和SPSS 26.0软件进行数据分析。 结果 2019—2022年甘肃省ICU临床分离菌均以革兰阴性菌为主，检出率分别为74.5%、75.0%、75.9%、75.5%，均以肺炎克雷伯菌的检出率最高。革兰阳性菌检出率均在25%左右，以金黄色葡萄球菌检出率最高，其中耐甲氧西林金黄色葡萄球菌的检出率分别为43.9%、43.3%、41.8%、42.7%，耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为83.9%、82.4%、81.8%、77.5%。粪肠球菌检出率呈下降趋势(χ²=5.229，P=0.021)。铜绿假单胞菌对多种抗菌药物耐药率低于33.9%，对氨基糖苷类和喹诺酮类药物耐药率呈下降趋势(P < 0.05)。鲍曼不动杆菌对氨基糖苷类、碳青霉烯类等多种药物耐药率呈上升趋势(P < 0.05)。MRCNS、耐碳青霉烯肺炎克雷伯菌的检出率均呈下降趋势(均P < 0.05)。 结论 2019—2022年甘肃省ICU临床分离病原菌主要为革兰阴性菌，多重耐药菌的检出率上升且耐药现状严重，应引起临床重视。加强病原菌监测及耐药分析，合理使用抗菌药物同时应加强落实感染预防与控制措施，避免医院感染及耐药菌的交叉传播导致更多耐药菌的出现。

Abstract:

Objective To analyze the distribution and antimicrobial resistance of clinically isolated bacteria in the intensive care units (ICUs) of Gansu Province, and provide basis for the rational antimicrobial use for ICU patients in this region. Methods Antimicrobial resistance monitoring data of clinically isolated bacteria from ICUs in hospitals of antimicrobial resistance surveillance system in Gansu Province from January 2019 to December 2022 were collected. Antimicrobial resistance were detected by disk diffusion method, minimum inhibitory concentration (MIC) method and E-test method, and the test results were judged according to the standards of American Clinical and Laboratory Standards Institute (CLSI). Data were analyzed using WHONET 5.6 and SPSS 26.0 softwares. Results From 2019 to 2022, Gram-negative bacteria were the main clinical isolates in ICUs in Gansu Province, with detection rates of 74.5%, 75.0%, 75.9%, and 75.5%, respectively. Klebsiella pneumoniae had the highest detection rate. Among Gram-positive bacteria, Staphylococcus aureus had the highest detection rate, all around 25%. The detection rates of methicillin-resistant Staphylococcus aureus were 43.9%, 43.3%, 41.8%, and 42.7%, respectively. The detection rates of methicillin-resistant coagulase negative Staphylococcus (MRCNS) were 83.9%, 82.4%, 81.8%, and 77.5%, respectively. Detection rate of Enterococcus faecalis showed a downward trend (χ²=5.229, P=0.021). The resistance rate of Pseudomonas aeruginosa to multiple antimicrobial agents was less than 33.9%, and the resistance rates to aminoglycosides and quinolones showed a decreasing trend (P < 0.05). The resistance rates of Acinetobacter baumannii to various antimicrobial agents such as aminoglycosides and carbapenems presented a rising trend (P < 0.05). The detection rates of MRCNS and carbapenem-resistant Klebsiella pneumo-niae showed a decreasing trend (both P < 0.05). Conclusion From 2019 to 2022, the main clinically isolated pathogenic bacteria in ICUs in Gansu Province were Gram-negative bacteria. The detection rate of multidrug-resistant organisms has increased and drug resistance was severe, which should be paid attention in clinic. It is necessary to strengthen pathogen monitoring and antimicrobial resistance analysis, use rational antimicrobial agents, as well as strengthen infection prevention and control measures, so as to avoid the emergence of more antimicrobial-resistant bacteria due to healthcare-associated infection and cross transmission of antimicrobial-resistant organisms.