中国四川省胆道感染的病原体及抗生素耐药模式的时间变化（2017 - 2023年）
Temporal Shifts in Etiological Agents and Antibiotic Resistance Patterns of Biliary Tract Infections in Sichuan Province, China (2017-2023).
作者信息
Li Yi, Li Dan, Huang Xiangning, Long Shanshan, Yu Hua, Zhang Jie
机构信息
School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
Department of Laboratory Medicine, Sichuan Provincial Key Laboratory for Human Disease Gene Study and the Center for Medical Genetics, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
出版信息
Infect Drug Resist. 2024 Oct 11;17:4377-4389. doi: 10.2147/IDR.S474191. eCollection 2024.
PURPOSE
We analyzed the pathogenic bacteria and antibiotic resistance distributions in patients with biliary tract infections (BTI) using samples from the Antimicrobial Resistant Investigation Network of Sichuan Province (ARINSP) to promote the rational use of antibiotics to reduce multidrug resistance.
PATIENTS AND METHODS
Participating hospitals identified isolates between 2017 and 2023 and conducted antimicrobial susceptibility tests. Isolated bacteria were identified and tested for drug sensitivity using MOLDI-TOF mass spectrometry system, VITEK automated drug sensitivity system and paper diffusion method, and the results were interpreted with reference to CLSI M100 30th edition standards. WHONET 5.6 was used to analyze the results.
RESULTS
In total, 25,573 bacterial isolates were collected; 18,134 were Gram-negative (70.9%). The top five most frequently isolated bacteria were (8,181/25,573; 32.0%), (3,247/25,573; 12.7%), (2,331/25,573; 9.1%), (1,714/25,573; 6.7%), and (1,429/25,573; 5.6%). and slowly declined over time, while slowly increased; frequency was stable; resistance to ampicillin was the highest among all antibiotics tested; resistance rates decreased with the addition of sulbactam. resistance to aztreonam, imipenem, meropenem, ertapenem, and chloramphenicol remained low. was highly resistant to cephalosporins, especially cefoxitin and cefazolin. resistance to teicoplanin remained low, decreasing from 6.9% in 2017 to 0.0% in 2019 before stabilizing.
CONCLUSION
The most frequently isolated bacteria from patients with BTIs were Enterobacteriaceae, including and , followed by and . Isolates exhibited high resistance to routinely used antibiotics (cephalosporins) and were highly sensitive to tigecycline, carbapenem, amikacin, and vancomycin. The results guide the rational use and continual revision of antibiotic regimens for BTIs to reduce antibiotic resistance.
目的
我们利用四川省抗菌药物耐药性调查网络（ARINSP）的样本，分析胆道感染（BTI）患者的病原菌及抗生素耐药性分布情况，以促进抗生素的合理使用，减少多重耐药性。
患者与方法
参与研究的医院在2017年至2023年期间鉴定分离株，并进行抗菌药物敏感性试验。使用基质辅助激光解吸电离飞行时间质谱系统、VITEK自动化药敏系统和纸片扩散法对分离出的细菌进行鉴定和药敏试验，并参照CLSI M100第30版标准解释结果。使用WHONET 5.6分析结果。
结果
共收集到25573株细菌分离株；其中18134株为革兰氏阴性菌（70.9%）。最常分离出的前五种细菌分别是大肠埃希菌（8181/25573；32.0%）、肺炎克雷伯菌（3247/25573；12.7%）、阴沟肠杆菌（2331/25573；9.1%）、鲍曼不动杆菌（1714/25573；6.7%）和铜绿假单胞菌（1429/25573；5.6%）。大肠埃希菌和肺炎克雷伯菌随时间缓慢下降，而阴沟肠杆菌缓慢上升；鲍曼不动杆菌的频率稳定；大肠埃希菌对所有测试抗生素中氨苄西林的耐药性最高；添加舒巴坦后耐药率下降。鲍曼不动杆菌对氨曲南、亚胺培南、美罗培南、厄他培南和氯霉素的耐药性仍然较低。阴沟肠杆菌对头孢菌素高度耐药，尤其是头孢西丁和头孢唑林。阴沟肠杆菌对替考拉宁的耐药性仍然较低，从2017年的6.9%降至2019年的0.0%，之后趋于稳定。
结论
BTI患者中最常分离出的细菌是肠杆菌科，包括大肠埃希菌和肺炎克雷伯菌，其次是鲍曼不动杆菌和铜绿假单胞菌。分离株对常用抗生素（头孢菌素）表现出高耐药性，对替加环素、碳青霉烯类、阿米卡星和万古霉素高度敏感。这些结果指导BTI抗生素治疗方案的合理使用和持续修订，以降低抗生素耐药性。
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