Abstract:

Objective　To understand the distribution of pathogenic bacteria and drug resistance in the department of infectious diseases and other departments in a 3A hospital in recent 5 years, so as to provide a basis for rational clinical application of antimicrobial drugs. Methods　All pathogenic bacteria sent for clinical examination in Binzhou Medical University Hospital from January 2017 to December 2021 were collected, and the distribution of strains, specimen sources, and drug resistance rate from the department of infectious diseases and other departments were analyzed. χ² test was used for statistical analysis. Results　A total of 25 433 non-repeated pathogenic strains were isolated, including 826 strains from the department of infectious diseases and 24 607 strains from other departments. The top three pathogenic bacteria in the department of infectious diseases were Escherichia coli [27.72% (229/826)], Klebsiella pneumoniae [11.50% (95/826)], and Brucella [7.51% (62/826)], and the main sources of specimens were blood [42.86% (354/826)], sputum [24.70% (204/826)], and urine [17.80% (147/826)]. The top three pathogenic bacteria in other departments were Escherichia coli [15.43% (3 797/24 607)], Klebsiella pneumoniae [12.08% (2 973/24 607)], and Staphylococcus aureus [11.19% (2 753/24 607)], and the main sources of specimens were sputum [28.41% (6 991/24 607)], urine [10.29% (2 531/24 607)], and blood [9.82% (2 417/24 607)]. The resistance rates of Escherichia coli isolated from the department of infectious diseases and other departments to ampicillin were the highest [85.15% (195/229) and 83.09% (3 155/3 797)], the resistance rates to levofloxacin were greater than 50%, and the resistance rates to amikacin, furantoin, carbapenems, piperacillin/tazobactam, and cefoperazone/sulbactam were all less than 10%. The resistance rates of Klebsiella pneumoniae isolated from the department of infectious diseases and other departments to cefazolin were the highest [23.16% (22/95) and 32.59% (969/2 973)], the resistance rates to carbapenems were less than 5%, and the resistance rates to third-generation cephalosporins were about 25%. Conclusions　Clinical isolation of pathogenic bacteria is mainly Gram-negative bacteria. Blood specimens and sputum specimens are the main sources of pathogenic bacteria detection, and standardization of specimen extraction and delivery is of great significance to the detection of pathogenic bacteria. The monitoring of pathogenic bacteria and the rational use of antimicrobial drugs should be given high priority by all clinical departments.

Key words:

Pathogenic bacteria, Drug resistance rate, Gram-negative bacteria, Department of infectious diseases

摘要：

目的　了解某三甲医院近5年感染性疾病科与其他科室病原菌分布以及耐药性情况，为临床合理应用抗菌药物提供依据。方法　收集滨州医学院附属医院2017年1月—2021年12月临床送检的全部病原菌，对来自感染性疾病科与其他科室菌株的分布、标本来源、耐药率等进行分析。采用χ²检验进行统计学分析。结果　共分离非重复菌株25 433株，其中来自感染性疾病科826株、来自其他科室24 607株。感染性疾病科病原菌前三位依次为大肠埃希菌27.72%（229/826）、肺炎克雷伯菌11.50%（95/826）、布鲁氏菌7.51%（62/826），标本来源主要为血液42.86%（354/826）、痰液24.70%（204/826）、尿液17.80%（147/826）。其他科室病原菌前三位依次为大肠埃希菌15.43%（3 797/24 607）、肺炎克雷伯菌12.08%（2 973/24 607）、金黄色葡萄球菌11.19%（2 753/24 607），主要标本来源为痰液28.41%（6 991/24 607）、尿液10.29%（2 531/24 607）、血液9.82%（2 417/24 607）。感染性疾病科与其他科室分离出的大肠埃希菌对氨苄西林耐药率最高，分别为85.15%（195/229）、83.09%（3 155/3 797），对左氧氟沙星的耐药率均大于50%，对阿米卡星、呋喃妥因、碳青霉烯类、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率均小于10%。感染性疾病科与其他科室分离出的肺炎克雷伯菌对头孢唑林耐药率最高，分别为23.16%（22/95）、32.59%（969/2 973），对碳青霉烯类耐药率均小于5%，对三代头孢菌素耐药率约为25%。结论　临床分离病原菌以革兰阴性菌为主，血液标本及痰液标本是病原菌检测的主要来源，规范标本抽取、送检对病原菌的检出意义重大。病原菌的监测及合理使用抗菌药物，应引起各临床科室的高度重视。

关键词:

病原菌, 耐药率, 革兰阴性菌, 感染性疾病科