中国东部一家三级医院COVID-19大流行期间血流感染的病原体分布及耐药性特征：与大流行前时期的比较
Characterization of the Pathogen Distribution and Drug Resistance in Bloodstream Infections During COVID-19 Pandemic in a Tertiary Hospital in Eastern China: Comparison with the Pre-Pandemic Period.
作者信息
Gu Min, Zhang Xiaohui, Ni Fang, Wang Jue, Xia Wenying, Lu Yanfei
机构信息
Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.
National Key Clinical Department of Laboratory Medicine, Nanjing, People's Republic of China.
出版信息
Infect Drug Resist. 2024 Aug 26;17:3689-3700. doi: 10.2147/IDR.S476267. eCollection 2024.
PURPOSE
To explore the characteristics of the pathogen distribution and drug resistance in bloodstream infections (BSIs) during the COVID-19 pandemic in a tertiary hospital in eastern China, and to compare them with those before the pandemic.
PATIENTS AND METHODS
Non-repetitive strain data of BSIs were retrospectively obtained before the COVID-19 pandemic (Pre-Pandemic, n=2698) and during the COVID-19 pandemic (Pandemic, n=2922), the distribution of pathogens and drug resistance were compared between the two groups.
RESULTS
The main pathogens of BSIs were Gram-negative bacteria (57.91%), followed by Gram-positive bacteria (32.58%), fungi and anaerobic bacteria accounting for 5.48% and 3.39%, respectively. and were the top 3 isolates. The proportion of and were significantly increased, while those of and were significantly decreased when compared to the Pre-Pandemic (<0.05). Carbapenem-resistant (CRE) significantly elevated during the Pandemic (17.4% vs 14.4%, =0.041); the detection of carbapenem-resistant (CRPA) significantly ascended (39.0% vs 24.4%, =0.016); and the proportion of carbapenem-resistant (CRAB) maintained stable (78.8%). Gram-positive bacteria had the lowest resistance to linezolid, vancomycin and tigecycline, which remained a stable trend with the Pre-Pandemic (<5.0%). The isolate rates of methicillin-resistant (MRSA) and vancomycin-resistant (VRE) were 38.9% and 1.0%, respectively. showed a decrease in the isolation rate of vancomycin minimum inhibitory concentration (MIC) ≤ 0.5 μg/mL (=7.676, =0.006) and an increase with vancomycin MIC=1 μg/mL (=9.008, =0.003).
CONCLUSION
The pathogen distribution and drug resistance of BSIs during the COVID-19 pandemic were transformed from Pre-Pandemic and accompanied by increasing bacterial resistance. Clinical management of antibiotic application and infection control should be strengthened.
目的
探讨中国东部一家三级医院在新型冠状病毒肺炎（COVID-19）大流行期间血流感染（BSIs）的病原菌分布特征及耐药情况，并与大流行前进行比较。
患者与方法
回顾性获取COVID-19大流行前（大流行前，n = 2698）和COVID-19大流行期间（大流行，n = 2922）BSIs的非重复菌株数据，比较两组病原菌分布及耐药情况。
结果
BSIs的主要病原菌为革兰阴性菌（57.91%），其次为革兰阳性菌（32.58%），真菌和厌氧菌分别占5.48%和3.39%。[具体细菌名称1]、[具体细菌名称2]和[具体细菌名称3]是前3位分离菌。与大流行前相比，[具体细菌名称1]和[具体细菌名称2]的比例显著增加，而[具体细菌名称3]和[具体细菌名称4]的比例显著降低（P<0.05）。碳青霉烯类耐药[具体细菌名称5]（CRE）在大流行期间显著升高（17.4% 对14.4%，P = 0.041）；碳青霉烯类耐药[具体细菌名称6]（CRPA）的检出率显著上升（39.0% 对24.4%，P = 0.016）；碳青霉烯类耐药[具体细菌名称7]（CRAB）的比例保持稳定（78.8%）。革兰阳性菌对利奈唑胺、万古霉素和替加环素的耐药性最低，与大流行前相比保持稳定趋势（P<5.0%）。耐甲氧西林[具体细菌名称8]（MRSA）和耐万古霉素[具体细菌名称9]（VRE）的分离率分别为38.9%和1.0%。[具体细菌名称10]显示万古霉素最低抑菌浓度（MIC）≤0.5 μg/mL的分离率降低（P = 7.676，P = 0.006），而万古霉素MIC = 1 μg/mL时分离率增加（P = 9.008，P = 0.003）。
结论
COVID-19大流行期间BSIs的病原菌分布和耐药情况与大流行前相比发生了变化，且细菌耐药性增加。应加强抗生素应用的临床管理和感染控制。
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