Zhuo C Y, Guo Y Y, Liu N J, Liu B M, Xiao S N, Zhang Y, Guo X C, Li D N, Tan S Y, He N H, Mai Y, Guan J, Zhuo C
The First Affiliated Hospital of Guangzhou Medical, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, Guangzhou 510030, China.
Zhonghua Xue Ye Xue Za Zhi. 2020 Dec 14;41(12):996-1001. doi: 10.3760/cma.j.issn.0253-2727.2020.12.005.
To evaluate the epidemiology of bacterial bloodstream infections in patients submitted to hematologic wards in southern China. A total of 50 teaching hospitals were involved based on the China Antimicrobial Resistance Surveillance System. The data of clinical isolates from blood samples were collected from January 1, 2019, to December 31, 2019. Antimicrobial susceptibility testing was conducted by the Kirby-Bauer automated systems, and the results were interpreted using the CLSI criteria. The data of 1,618 strains isolated from hematologic wards in 2019 were analyzed, of which gram-negative bacilli and gram-positive cocci accounted for 71.8% and 28.2%, respectively. Of those, the five major species were most often isolated, including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, coagulase-negative staphylococcus, and Streptococcus viridans. The prevalence rates of methicillin-resistant strains in Staphylococcus aureus and coagulase-negative staphylococcus were 19.7% and 80.6%, respectively. No gram-positive cocci were resistant to vancomycin, linezolid, and teicoplanin, and none of the enterococci were resistant to linezolid. The resistance rate of S. viridans to penicillin G was 6.9%, and those to ceftriaxone and cefotaxime were more than 25%. The resistance rate of E. coli and K. pneumoniae in Enterobacteriaceae was higher in children than that in adults. The resistance rate of K. pneumoniae to meropenem was 14.1%. The resistant rate of Enterobacter cloacae to carbapenem was more than 25%. P. aeruginosa was more sensitive to more antibiotics than 80%, but the resistance rate to meropenem in children was higher than that in adults (11.8% vs. 6.5%). The proportion of gram-positive cocci in the ICU and respiratory departments was higher than that in the hematology department. The detection rates of carbapenem-resistant E. coli and K. pneumoniae in the respiratory department were the lowest with 0.3% and 3.7%, respectively, while those of CRPA and CRAB in the hematology department were the lowest with 8.3% and 25.8%, respectively. The detection rate of all carbapenem-resistant organisms in the ICU was the highest among the three departments. The etiology and drug resistance of bacteria from blood samples in the hematology department are different from those in the ICU and respiratory departments. The proportions of K. pneumoniae, P. aeruginosa, E. cloacae, and S. viridans dominating in the department of Hematology were significantly higher than those in the ICU and respiratory departments in Guangdong region.
评估中国南方血液科病房患者细菌血流感染的流行病学情况。基于中国抗菌药物耐药性监测系统，共有50家教学医院参与其中。收集了2019年1月1日至2019年12月31日血液样本的临床分离株数据。采用 Kirby - Bauer自动化系统进行药敏试验，并根据CLSI标准解释结果。对2019年从血液科病房分离出的1618株菌株的数据进行了分析，其中革兰氏阴性杆菌和革兰氏阳性球菌分别占71.8%和28.2%。其中，最常分离出的五种主要菌种包括大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、凝固酶阴性葡萄球菌和草绿色链球菌。金黄色葡萄球菌和凝固酶阴性葡萄球菌中耐甲氧西林菌株的流行率分别为19.7%和80.6%。没有革兰氏阳性球菌对万古霉素、利奈唑胺和替考拉宁耐药，也没有肠球菌对利奈唑胺耐药。草绿色链球菌对青霉素G的耐药率为6.9%，对头孢曲松和头孢噻肟的耐药率超过25%。肠杆菌科中大肠埃希菌和肺炎克雷伯菌在儿童中的耐药率高于成人。肺炎克雷伯菌对美罗培南的耐药率为14.1%。阴沟肠杆菌对碳青霉烯类的耐药率超过25%。铜绿假单胞菌对多种抗生素的敏感率超过80%，但儿童对美罗培南的耐药率高于成人（11.8%对6.5%）。重症监护病房（ICU）和呼吸科革兰氏阳性球菌的比例高于血液科。呼吸科碳青霉烯类耐药大肠埃希菌和肺炎克雷伯菌的检出率最低，分别为0.3%和3.7%，而血液科耐碳青霉烯类铜绿假单胞菌（CRPA）和耐碳青霉烯类鲍曼不动杆菌（CRAB）的检出率最低，分别为8.3%和25.8%。三个科室中，ICU所有耐碳青霉烯类菌的检出率最高。血液科血液样本中细菌的病因和耐药性与ICU和呼吸科不同。在广东地区，血液科中肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌和草绿色链球菌占主导的比例显著高于ICU和呼吸科。
