2017-2024年山东地区不同人群常用静脉导管分离菌的构成及药敏分析

Composition and antimicrobial susceptibility analysis of bacteria isolated from commonly used venous catheters in different populations in Shandong from 2017 to 2024

    摘要
  • 摘要:
    目的 分析山东地区静脉导管分离菌的构成、耐药性特征及年龄分布, 为导管相关性血流感染的病原学诊断、院内感染防控和护理实践提供依据。
    方法 回顾性分析山东省儿童细菌 & 真菌耐药监测研究协作网59家医疗机构2017年1月-2024年12月符合Maki半定量培养标准的导管尖端5 cm片段分离菌株数据, 使用WHONET 5.6软件进行统计分析。
    结果 共分离1 087菌株, 纳入1 007株, 革兰阳性菌占52.83%, 以表皮葡萄球菌、金黄色葡萄球菌和屎肠球菌为主；革兰阴性菌占38.83%, 以克雷伯菌属、肠杆菌属和不动杆菌属多见；真菌占8.34%, 以念珠菌属为主。年龄分布方面：儿童组主要病原菌为表皮葡萄球菌、溶血葡萄球菌、人葡萄球菌、屎肠球菌和金黄色葡萄球菌；成人组主要为表皮葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌和铜绿假单胞菌。耐药性分析显示, 耐甲氧西林表皮葡萄球菌检出率(86.64%)高于耐甲氧西林金黄色葡萄球菌(26.56%)(χ2=89.540, P＜0.001)。肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率为37.96%, 高于国内其他部位报道(P＜0.05)；鲍曼不动杆菌对碳青霉烯类抗菌药物的耐药率>70%, 对替加环素耐药率仅为2.00%。
    结论 山东地区不同人群静脉导管分离菌种类及耐药性存在明显差异, 持续开展病原学与耐药性监测对提升导管相关性血流感染精准诊治、医院感染防控及临床合理用药水平具有重要意义。

     

    Abstract:
    OBJECTIVE To analyze the composition, drug resistance characteristics and age distribution of bacteria isolated from venous catheters in Shandong, providing evidence for the etiological diagnosis, hospital-associated infection prevention and control and nursing practices for catheter-related bloodstream infections.
    METHODS A retrospective analysis was conducted on data from bacteria isolated from 5cm segments of catheter tips meeting Maki′s semi-quantitative culture criteria, collected from 59 medical institutions in the Shandong Province Pediatric Bacterial & Fungal Antimicrobial Resistance Surveillance System (SPARSS) from Jan. 2017 to Dec. 2024. Statistical analysis was performed with WHONET 5.6 software.
    RESULTS A total of 1 087 strains were isolated, with 1 007 strains included in the analysis. Gram-positive bacteria accounted for 52.83%, primarily consisting of Staphylococcus epidermidis, Staphylococcus aureus and Enterococcus faecium. Gram-negative bacteria accounted for 38.83%, with Klebsiella spp. Enterobacter spp. and Acinetobacter spp. being the most common. Fungi accounted for 8.34%, mainly Candida spp. In terms of age distribution, the main pathogens in the child group were S. epidermidis, Staphylococcus haemolyticus, Staphylococcus hominis, E. faecium and S. aureus. While in the adult group, they were primarily S. epidermidis, Klebsiella pneumoniae, Acinetobacter baumannii, S. aureus and Pseudomonas aeruginosa. Antimicrobial resistance analysis revealed that the detection rate (86.64%) of methicillin-resistant S. epidermidis was higher than that of methicillin-resistant S. aureus (26.56%) (χ2=89.540, P < 0.001). The resistance rate of K. pneumoniae to carbapenem antimicrobial agents was 37.96%, higher than that reported in other regions of China (P < 0.05). The resistance rate of A. baumannii to carbapenem antimicrobial agents was >70%, while its resistance rate to tigecycline was only 2.00%.
    CONCLUSIONS There are significant differences in the types and drug resistance of bacteria isolated from venous catheters among different populations in Shandong. Continuous surveillance of etiology and drug resistance is of great significance for improving the precise diagnosis and treatment of catheter-related bloodstream infections, hospital-associated infection prevention and control and the rational use of drugs in clinical practice.

     

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