Liu Guoliang, Qin Mingzhao
Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Evid Based Complement Alternat Med. 2022 Sep 16;2022:3512582. doi: 10.1155/2022/3512582. eCollection 2022.
Antibiotic resistance is a global public health problem, leading to high mortality and treatment costs. To achieve more efficient treatment protocols and better patient recovery, the distribution and drug resistance of pathogens in our hospital were investigated, allowing significant clinical guidance for the use of antimicrobials.
In this retrospective study (2017-2019), 3482 positive samples were isolated from 43,981 specimens in 2017; 3750 positive specimens were isolated from 42,923 specimens in 2018; and 3839 positive pathogens were isolated from 46,341 specimens in 2019. These samples were from various parts of the patients, including the respiratory tract, urine, blood, wound secretions, bile, and puncture fluids. The distribution and antibiotic resistance of these isolated pathogens from the whole hospital were analyzed.
The results from pathogen isolation showed that (12.8%), (11%), (10.8%), (10.7%), and (6.4%) represented the five main pathogenic bacteria in our hospital. (16.2% and 17.5%) occupied the largest proportion in the central intensive care unit (central ICU) and respiratory intensive care unit (RICU), while (15.4%) was the most common pathogen in the emergency intensive care unit (EICU). The resistance rate of to trimethoprim and minocycline was 100%, and the sensitivity rate to ertapenem, furantoin, and amikacin was above 90%. The resistance rate of to all antibiotics, such as piperacillin and ciprofloxacin, was under 40%. The sensitivity rate of to tigecycline and minocycline was less than 30%, and the resistance rate to many drugs such as piperacillin, ceftazidime, and imipenem was above 60%. Extended-spectrum -lactamases (ESBLs)-producing (ESBLs-KPN) and carbapenem-resistant (CRE-KPN), ESBLs-producing (ESBLs-ECO) and carbapenem-resistant (CRE-ECO), multidrug-resistant (MDR-AB), multidrug-resistant (MDR-PAE), and methicillin-resistant (MRSA) are all important multidrug-resistant bacteria found in our hospital. The resistance rate of ESBLs-producing to ceftriaxone and amcarcillin-sulbactam was above 95%. CRE bacteria showed the highest resistance to amcarcillin-sulbactam (97.1%), and the resistance rates of MDR-AB to cefotaxime, cefepime, and aztreonam were 100%. The resistance rates of MDR-PAE to ceftazidime, imipenem, and levofloxacin were 100%, and the sensitivity rate to polymyxin B was above 98%. The resistance rate of MRSA to oxacillin was 100%, and the sensitivity rate to linezolid and vancomycin was 100%.
The distribution of pathogenic bacteria in different hospital departments and sample sources was markedly different. Therefore, targeted prevention and control of key pathogenic bacteria in different hospital departments is necessary, and understanding both drug resistance and multiple drug resistance of the main pathogenic bacteria may provide guidance for the rational use of antibiotics in the clinic.
抗生素耐药性是一个全球性的公共卫生问题，会导致高死亡率和治疗成本。为了实现更有效的治疗方案和更好的患者康复效果，我们对本院病原体的分布及耐药情况进行了调查，为抗菌药物的使用提供了重要的临床指导。
在这项回顾性研究（2017 - 2019年）中，2017年从43981份标本中分离出3482份阳性样本；2018年从42923份标本中分离出3750份阳性标本；2019年从46341份标本中分离出3839份阳性病原体。这些样本来自患者的各个部位，包括呼吸道、尿液、血液、伤口分泌物、胆汁和穿刺液。对全院分离出的这些病原体的分布及抗生素耐药情况进行了分析。
病原体分离结果显示，（12.8%）、（11%）、（10.8%）、（10.7%）和（6.4%）是我院的五种主要病原菌。（16.2%和17.5%）在中心重症监护病房（中心ICU）和呼吸重症监护病房（RICU）中占比最大，而（15.4%）是急诊重症监护病房（EICU）中最常见的病原体。对甲氧苄啶和米诺环素的耐药率为100%，对厄他培南、呋喃妥因和阿米卡星的敏感率高于90%。对所有抗生素如哌拉西林和环丙沙星的耐药率均低于40%。对替加环素和米诺环素的敏感率低于30%，对哌拉西林、头孢他啶和亚胺培南等多种药物的耐药率高于60%。产超广谱β-内酰胺酶（ESBLs）的（ESBLs-KPN）和耐碳青霉烯类的（CRE-KPN）、产ESBLs的（ESBLs-ECO）和耐碳青霉烯类的（CRE-ECO）、多重耐药的（MDR-AB）、多重耐药的（MDR-PAE）以及耐甲氧西林的（MRSA）都是我院发现的重要多重耐药菌。产ESBLs的对头孢曲松和阿莫西林-舒巴坦的耐药率高于95%。耐碳青霉烯类肠杆菌科细菌对阿莫西林-舒巴坦的耐药率最高（97.1%），MDR-AB对头孢噻肟、头孢吡肟和氨曲南的耐药率为100%。MDR-PAE对头孢他啶、亚胺培南和左氧氟沙星的耐药率为100%，对多粘菌素B的敏感率高于98%。MRSA对苯唑西林的耐药率为100%，对利奈唑胺和万古霉素的敏感率为100%。
不同医院科室和样本来源的病原菌分布存在显著差异。因此，有必要针对不同医院科室的关键病原菌进行有针对性的预防和控制，了解主要病原菌的耐药性和多重耐药性可为临床合理使用抗生素提供指导。
