某三甲医院7年间血流感染细菌分布及耐药性分析
Distribution and Drug Resistance Analysis of Bloodstream Infection Bacteria in a Tertiary Hospital in 7 Years
DOI: 10.12677/acm.2025.15123606, PDF,    科研立项经费支持
作者: 莫双铭, 游海涛*:岳池县人民医院药剂科,四川 广安;唐钰书:岳池县人民医院肾内科,四川 广安
关键词: 血流感染细菌耐药监测抗菌药物Bloodstream Infection Bacterial Resistance Surveillance Antimicrobial Drugs
摘要: 目的:分析广安市某医院血流感染常见感染病原菌的动态变化。方法:纳入2018年~2024年血培养阳性1574株血流感染病原菌,分析病原菌分布及药敏结果。结果:革兰阴性菌57.4%,革兰阳性菌41.4%,真菌19株。药敏结果显示MRSA和MRSCNS检出率为35.2%和72.5%,葡萄球菌属中鉴定出3株万古霉素耐药株,发现1例利奈唑胺和替考拉宁耐药株;监测显示,产酶(ESBLs)株大肠埃希菌对头孢吡肟、环丙沙星敏感率呈下降趋势;大肠埃希菌对阿莫西林/克拉维酸耐药率下降。结论:2018年~2024年广安地区血流感染部分病原谱呈现显著变迁,提示应提高相关病原菌和易感人群的持续监测,加强抗生素使用策略、优化感染防控措施。
Abstract: Objective: To analyze the dynamic changes of common pathogens of bloodstream infection in a hospital in Guang’an. Methods: A 1574 strains of blood-flow infection pathogens with positive blood culture from 2018 to 2024 were included, and the distribution and drug sensitivity of pathogens were analyzed. Results: Gram-negative bacteria: 57.4%, gram-positive bacteria: 41.4%, and 19 cases were fungi. The detection rates of methicillin-resistant S. aureus (MRSA)and methicillin-resistant coagulase-negative Staphylococci (MRCNS) were 35.2% and 72.5%. There are 3 vancomycin-resistant strains in Staphylococcus, 1 linezolid and teicoplanin-resistant strain. Monitoring data shows a decreasing trend in the susceptibility of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli strains to cefepime and ciprofloxacin; the resistance rate of Escherichia coli to amoxicillin/clavulanic acid is also decreasing. Conclusion: From 2018 to 2024, some pathogens of bloodstream infection in this area changed greatly, suggesting that continuous monitoring of related pathogens and susceptible populations should be improved, antibiotic use strategies should be strengthened, and infection prevention and control measures should be optimized.
文章引用:莫双铭, 唐钰书, 游海涛. 某三甲医院7年间血流感染细菌分布及耐药性分析[J]. 临床医学进展, 2025, 15(12): 1884-1891. https://doi.org/10.12677/acm.2025.15123606

参考文献

[1] Nolivos, S., Cayron, J., Dedieu, A., Page, A., Delolme, F. and Lesterlin, C. (2019) Role of AcrAB-TolC Multidrug Efflux Pump in Drug-Resistance Acquisition by Plasmid Transfer. Science, 364, 778-782. [Google Scholar] [CrossRef] [PubMed]
[2] 郑娅琼, 刘炎, 刘磊, 等. 血流细菌性感染诊断的研究进展[J]. 国际检验医学杂志, 2023, 44(16): 2034-2038.
[3] Agency for Healthcare Research and Quality (2024) An Assessment of Sepsis in the United States and Its Burden on Hospital Care. Agency for Healthcare Research and Quality.
[4] Lafuente, C.E., Terradas, R.R., Civit, C.A., et al. (2023) Risk Factors of Catheter-Associated Bloodstream Infection: Systematic Review and Meta-Analysis. PLOS ONE, 18, e0282290. [Google Scholar] [CrossRef] [PubMed]
[5] Timsit, J., Ruppé, E., Barbier, F., Tabah, A. and Bassetti, M. (2020) Bloodstream Infections in Critically Ill Patients: An Expert Statement. Intensive Care Medicine, 46, 266-284. [Google Scholar] [CrossRef] [PubMed]
[6] Patini, R., Mangino, G., Martellacci, L., Quaranta, G., Masucci, L. and Gallenzi, P. (2020) The Effect of Different Antibiotic Regimens on Bacterial Resistance: A Systematic Review. Antibiotics, 9, 22-37. [Google Scholar] [CrossRef] [PubMed]
[7] Hu, F., Yuan, L., Yang, Y., Xu, Y., Huang, Y., Hu, Y., et al. (2022) A Multicenter Investigation of 2773 Cases of Bloodstream Infections Based on China Antimicrobial Surveillance Network (CHINET). Frontiers in Cellular and Infection Microbiology, 12, Article ID: 1075185. [Google Scholar] [CrossRef] [PubMed]
[8] 张凯, 喻华, 刘鑫, 等. 四川省细菌耐药监测网2021-2023年耐碳青霉烯革兰阴性杆菌分布特点及变化趋势[J]. 中国抗生素杂志, 2025(7): 798-806.
[9] Tamma, P.D., Aitken, S.L., Bonomo, R.A., Mathers, A.J., van Duin, D. and Clancy, C.J. (2022) Infectious Diseases Society of America 2022 Guidance on the Treatment of Extended-Spectrum β-Lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa). Clinical Infectious Diseases, 75, 187-212. [Google Scholar] [CrossRef] [PubMed]
[10] Cui, J., Li, M., Cui, J., Wang, J., Qiang, X. and Liang, Z. (2021) The Proportion, Species Distribution and Dynamic Trends of Bloodstream Infection Cases in a Tertiary Hospital in China, 2010-2019. Infection, 50, 121-130. [Google Scholar] [CrossRef] [PubMed]
[11] Reuter, S.E., Stocker, S.L., Alffenaar, J.C., Baldelli, S., Cattaneo, D., Jones, G., et al. (2022) Optimal Practice for Vancomycin Therapeutic Drug Monitoring: Position Statement from the Anti-Infectives Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology. Therapeutic Drug Monitoring, 44, 121-132. [Google Scholar] [CrossRef] [PubMed]
[12] Am, J.H., Jennifer, L., Thomas, P., et al. (2023) Therapeutic Monitoring of Vancomycin for Serious-Methicillin-Resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Clinical Infectious Diseases, 44, 1-31.
[13] 熊文艺, 刘成军. 万古霉素的药物动力学及治疗药物监测研究进展[J]. 儿科药学杂志, 2023, 29(1): 60-64.
[14] Xu, S., Li, Y., Xu, X., Su, J., Zhu, D., Hu, F., et al. (2018) A Case-Control Study: Clinical Characteristics of Nosocomial Bloodstream Infections versus Non-Bloodstream Infections of Acinetobacter spp. Clinical Infectious Diseases, 67, S189-S195. [Google Scholar] [CrossRef] [PubMed]
[15] 李耘, 郑波, 薛峰, 等. 中国细菌耐药监测研究(CARST) 2021-2022年革兰氏阴性菌监测报告[J]. 中国临床药理学杂志, 2023, 0(23): 3525-3544.
[16] 车立媛, 邹涵志, 于占彪. 重症监护室内患者血流感染诊疗的研究进展[J]. 中国临床研究, 2024, 37(11): 1770-1777.
[17] 赵平, 解泽强, 陈亮. 耐碳青霉烯类药物肠杆菌科细菌耐药特点和感染危险因素分析[J]. 标记免疫分析与临床, 2025(2): 233-237.
[18] 杨启文, 吴安华, 胡必杰, 等. 临床重要耐药菌感染传播防控策略专家共识[J]. 中国感染控制杂志, 2021, 20(1): 1-14.
[19] 杨莉, 陈茜, 陈明洁, 等. 某医院重症监护病房物体表面耐甲氧西林金黄色葡萄球菌污染状况分析[J]. 中国消毒学杂志, 2021, 38(1): 25-27.