广东省2019—2023年耐万古霉素屎肠球菌检出率升高的时空变迀研究

Spatiotemporal variation of the increased detection rate of vancomycin-resistant Enterococcus faecium in Guangdong Province, 2019-2023

摘要:

目的 分析近年广东省耐万古霉素屎肠球菌(VR-Efm)临床分离株的时空分布, 探寻VR-Efm检出率上升的原因。 方法 回顾性分析2019—2023年广东省4个区域(珠三角、粤东、粤西、粤北)的38所医疗机构上报至广东省细菌耐药监测系统中VR-Efm检出情况、患者人口学特征及科室和标本分布等资料, 同步分析世界卫生组织重点关注的ESKAPE中其他5种细菌的检出情况。 结果 广东省VR-Efm检出率从2019年1.4% (63/4 543)上升至2023年21.3%(1 351/6 345), 呈明显上升趋势, 2023年44.7%(17所)的医疗机构VR-Efm检出率＞20%; 广东省4个区域VR-Efm检出率普遍上升, 以珠三角地区为中心向周围辐射增长。ESKAPE整体由2019年10.1%升至2023年10.8%, 其余5种病原体中, 耐碳青霉烯类肺炎克雷伯菌检出率从2019年8.0%上升至2023年15.0%, 耐碳青霉烯类鲍曼不动杆菌、耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类铜绿假单胞菌和耐碳青霉烯类肠杆菌属检出率分别从2019年的61.6%、34.4%、21.2%、7.9% 下降至2023年的58.2%、31.9%、21.0%、7.6%, 皆有不同程度下降。ICU VR-Efm检出率(12.2%)高于门急诊(9.4%)、内科(9.2%)和外科(7.0%)等非ICU科室(均P < 0.05)。VR-Efm检出率较高标本分别为尿(9.8%)、血(9.1%), 其余标本检出率介于6.9%~9.6%。青少年患者VR-Efm检出率(4.4%)低于中老年患者(＞9.4%, P < 0.05)。 结论 近5年广东省VR-Efm检出率明显上升, 可能与社区和医院获得的优势克隆传播有关。有条件的医疗机构应对入院患者开展VR-Efm的筛查, 并对检出VR-Efm的患者采取有效防控措施, 以遏制VR-Efm检出率在该区域的上升。

Abstract:

Objective To analyze the spatiotemporal distribution of clinically isolated vancomycin-resistant Enterococcus faecium (VR-Efm) in Guangdong Province in recent years, and explore the causes for the increase in VR-Efm detection rate. Methods A retrospective analysis was conducted on the data about the detection, patients' demographic characteristics, as well as departments and specimens distribution of VR-Efm reported to Guangdong Province Antimicrobial Resistance Surveillance System by 38 medical institutions in 4 regions of Guangdong Province (Pearl River Delta, East Guangdong, West Guangdong, and North Guangdong) in 2019-2023. The detection of 5 other antimicrobial-resistant ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species) concerned by World Health Organization was analyzed synchronously. Results The detection rate of VR-Efm in Guangdong Province increased from 1.4%(63/4 543) in 2019 to 21.3% (1 351/6 345) in 2023, showing a significant upward trend. In 2023, 44.7% (n=17) medical institutions had a VR-Efm detection rate of >20%; the detection rate of VR-Efm in 4 regions of Guangdong Province has generally increased, with a radiation increase from the Pearl River Delta region to the surrounding areas. The overall ESKAPE increased from 10.1% in 2019 to 10.8% in 2023. Among the other 5 pathogens, the detection rate of carbapenem-resistant Klebsiella pneumoniae increased from 8.0% in 2019 to 15.0% in 2023. The detection rates of carbapenem-resistant Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacter spp. decreased from 61.6%, 34.4%, 21.2%, and 7.9% in 2019 to 58.2%, 31.9%, 21.0%, and 7.6% in 2023, respectively, all showed varying degrees of decline. The detection rate of VR-Efm in intensive care unit (ICU) (12.2%) was higher than that in non-ICU departments such as outpatient and emergency department (9.4%), internal medicine department (9.2%) and surgery department (7.0%) (all P < 0.05). The specimens with higher detection rates of VR-Efm were urine (9.8%) and blood (9.1%), while the detection rates of other specimens ranged from 6.9% to 9.6%. The detection rate of VR-Efm from adolescent patients was lower than that of middle-aged and elderly patients (4.4% vs >9.4%, P < 0.05). Conclusion In the past 5 years, the detection rate of VR-Efm in Guangdong Province has significantly increased, which may be related to the transmission of dominant clone acquired from communities and hospitals. Medical institutions with favorable condition should conduct VR-Efm screening for hospitalized patients, take effective prevention and control measures for patients with VR-Efm, so as to curb the increase in detection rate of VR-Efm in the region.