Gao Sui, Jian Cui
Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Curr Med Sci. 2024 Dec;44(6):1193-1201. doi: 10.1007/s11596-024-2959-y. Epub 2024 Dec 2.
To investigate the distribution characteristics of common bacteria and changes in antimicrobial resistance in intensive care unit (ICU) patients in 58 hospitals in Hubei Province from 2020-2023.
The antimicrobial agents for antimicrobial susceptibility tests was selected based on the 2022 China Antimicrobial Resistance surveillance system (CARSS) technical scheme, and the specific experimental operation was based on the requirements of the CLSI M02 and M07 documents. The commercial instruments were used following the manufacturer's instructions. The interpretation of antimicrobial susceptibility test results was based on the 2023 CLSI M100 standard.
There were 15 585, 19 258, 23 423 and 22 395 clinical isolates in the ICU from 2020 to 2023, respectively. Among them, gram-positive bacteria accounted for 20.5% (3190/15 585), 21.2% (4089/19 258), 21.6% (5067/23 423) and 21.6% (4 831/22 395), respectively. Gram-negative bacteria accounted for 79.5% (12 395/15 585), 78.8% (15 169/19 258), 78.4% (18 356/23 423) and 78.4% (17 564/22 395) of the bacteria, respectively. The top 5 isolates of gram-positive bacteria were Staphylococcus aureus, Enterococcus faecium, Streptococcus pneumoniae, Enterococcus faecalis, Staphylococcus epidermidis and gram-negative bacteria were Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Stenotrophomonas maltophil, respectively, but the proportions and rankings of the isolates in different years slightly differed. The detection rate of methicillin-resistant S. aureus (MRSA) decreased from 44.4% in 2020 to 36% in 2023, and that of methicillin-resistant coagulase-negative Staphylococcus (MRCNS) decreased from 79.8% in 2020 to 73.8% in 2022 and increased to 78.4% in 2023. The detection rates of both vancomycin-resistant E. faecium and E. faecalis were lower than 1%. The detection rate of carbapenem-resistant P. aeruginosa (CRPA) decreased from 25% in 2020 to 19.7% in 2022 and increased slightly to 20.6% in 2023. The detection rate of carbapenem-resistant A. baumannii (CRAB) decreased from 81.9% in 2020 to 79.7% in 2022 and increased to 82.9% in 2023. The detection rate of third-generation cephalosporin-resistant E. coli decreased from 59.8% in 2020 to 53.1% in 2022 and increased to 52.5% in 2023. The detection rate of fluoroquinolone-resistant E. coli decreased from 62.7% in 2020 to 50.2% in 2022 and increased slightly to 51.0% in 2023. The detection rate of carbapenem-resistant E. coli (CRECO) decreased from 3.3% in 2020 to 1.8% in 2022 and slightly increased to 2.1% in 2023. The detection rate of third-generation cephalosporin-resistant K. pneumoniae decreased from 34.3% in 2020 to 26.3% in 2022 and then increased to 32.4% in 2023. The detection rate of carbapenem-resistant K. pneumoniae (CRKPN) increased from 17.9% to 19.4% in 2020, decreased to 13.2% in 2022, and rose sharply to 20.4% in 2023.
MRSA showed a continuous downwards trend from 2020 to 2023, while the detection rates of MRCNS and most multidrug-resistant gram-negative bacteria continuously decreased from 2020 to 2022 but tended to increase in 2023. Therefore, it is still necessary to strengthen the monitoring of bacterial resistance and rational application of antibiotics and actively and effectively control nosocomial infections.
调查2020 - 2023年湖北省58家医院重症监护病房（ICU）患者常见细菌的分布特征及抗菌药物耐药性变化。
根据《2022年全国抗菌药物耐药监测技术方案》选择用于药敏试验的抗菌药物，具体实验操作依据CLSI M02和M07文件要求。使用商业仪器时遵循制造商的说明。药敏试验结果的判读依据2023年CLSI M100标准。
2020年至2023年ICU临床分离株分别有15585株、19258株、23423株和22395株。其中，革兰阳性菌分别占20.5%（3190/15585）、21.2%（4089/19258）、21.6%（5067/23423）和21.6%（4831/22395）。革兰阴性菌分别占细菌总数的79.5%（12395/15585）、78.8%（15169/19258）、78.4%（18356/23423）和78.4%（17564/22395）。革兰阳性菌前5位分离株分别为金黄色葡萄球菌、粪肠球菌、肺炎链球菌、屎肠球菌、表皮葡萄球菌；革兰阴性菌前5位分离株分别为肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、铜绿假单胞菌和嗜麦芽窄食单胞菌，但不同年份分离株的比例和排名略有差异。耐甲氧西林金黄色葡萄球菌（MRSA）的检出率从2020年的44.4%降至2023年的36%，耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率从2020年的79.8%降至2022年的73.8%，2023年又升至78.4%。耐万古霉素粪肠球菌和屎肠球菌的检出率均低于1%。耐碳青霉烯类铜绿假单胞菌（CRPA）的检出率从2020年的25%降至2022年的19.7%，2023年略有上升至20.6%。耐碳青霉烯类鲍曼不动杆菌（CRAB）的检出率从2020年的81.9%降至2022年的79.7%，2023年升至82.9%。耐第三代头孢菌素大肠埃希菌的检出率从2020年的59.8%降至2022年的53.1%，2023年升至52.5%。耐氟喹诺酮类大肠埃希菌的检出率从2020年的62.7%降至2022年的50.2%，2023年略有上升至51.0%。耐碳青霉烯类大肠埃希菌（CRECO）的检出率从2020年的3.3%降至2022年的1.8%，2023年略有上升至2.1%。耐第三代头孢菌素肺炎克雷伯菌的检出率从2020年的34.3%降至2022年的26.3%，2023年又升至32.4%。耐碳青霉烯类肺炎克雷伯菌（CRKPN）的检出率从2020年的17.9%升至19.4%，2022年降至13.2%，2023年大幅升至20.4%。
2020 - 2023年MRSA呈持续下降趋势，而MRCNS及多数多重耐药革兰阴性菌的检出率在2020 - 2022年持续下降，但2023年有上升趋势。因此，仍需加强细菌耐药监测及抗生素合理应用，积极有效控制医院感染。
