2019年安徽省皖北、皖中和皖南地区细菌耐药差异性分析

贺玲玲; 刘艳艳; 李家斌

doi:10.16462/j.cnki.zhjbkz.2021.07.022

2019年安徽省皖北、皖中和皖南地区细菌耐药差异性分析

doi: 10.16462/j.cnki.zhjbkz.2021.07.022

贺玲玲¹,
刘艳艳^{1, 2},
李家斌^{1, 2, ,}

1.
230022 合肥，安徽医科大学第一附属医院感染科
2.
230022 合肥，安徽省细菌耐药监测中心，安徽医科大学细菌耐药研究所

基金项目:

国家自然科学基金 81973983

国家科技重大专项 2017ZX10204401

2019年度合肥市“借转补”项目 J2019Y04

详细信息

通讯作者:
李家斌，E-mail：lijiabin@ahmu.edu.cn

中图分类号: R378
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- 被引次数: 0
出版历程
- 收稿日期: 2021-01-03
- 修回日期: 2021-03-02
- 网络出版日期: 2021-08-13
- 刊出日期: 2021-07-10

The analysis of antimicrobial resistance for bacteria among northern, central and southern Anhui Province in 2019

HE Ling-ling¹,
LIU Yan-yan^{1, 2},
LI Jia-bin^{1, 2
, ,}

1.
Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
2.
Anhui Center for Surveillance of Bacterial Resistance, Institute of Bacterial Resistance, Anhui Medical University, Hefei 230022, China

Funds:

National Natural Science Foundation of China 81973983

National Science and Technology Major Project 2017ZX10204401

Borrowing and Transferring Subsidy Project in 2019, Hefei J2019Y04

More Information

Corresponding author: LI Jia-bin, E-mail: lijiabin@ahmu.edu.cn

摘要

摘要: 目的分析2019年安徽省皖北、皖中和皖南地区细菌临床分布和耐药差异性，为不同地区临床医生选择抗菌药物提供合理参考。方法收集2019年安徽省细菌耐药监测网38家成员单位临床分离菌株按地区分成皖北、皖中和皖南地区，采用WHONET 5.6软件和SPSS 17.0软件进行统计分析。结果皖北地区耐甲氧西林金黄色葡萄球菌检出率高于皖中和皖南地区，铜绿假单胞菌和鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率分别为20.8%和60.4%；皖中地区耐碳青霉烯肺炎克雷伯菌高于皖北和皖南地区，肺炎克雷伯菌对头孢菌素类耐药率＞40.0%，对亚胺培南和美洛培南耐药率＞20.0%；皖南地区耐甲氧西林葡萄球菌对氨基糖苷类和喹诺酮类耐药率高于皖北地区。结论安徽省不同地区之间细菌耐药差异明显，需根据本地区细菌耐药情况合理选用抗菌药物。
- 细菌耐药 /
- 病原菌 /
- 抗菌药物 /
- 耐药性
Abstract: Objective To analyze the differences of clinical distribution and antimicrobial resistance of pathogenic bacteria among northern central and southern Anhui in 2019, and to provide a rational reference for clinicians in different regions. Methods The strains were collected from 38 hospitals of Anhui Center for Surveillance of Bacterial Resistance in 2019. Strains divided were according to northern, central and southern Anhui by region. WHONET 5.6 software and SPSS17.0 software were used for data analysis. Results The percentage of Methicillin-resistant Staphylococcus aureus in northern Anhui was higher than in central and southern Anhui. The resistance rates of cefoperazone/sulbactam for Pseudomonas aeruginosa and Acinetobacter baumannii were 20.8% and 60.4%, respectively. The percentage of Carbapenem-resistant Klebsiella pneumoniae in central Anhui was higher than those in northern Anhui and southern Anhui. The resistance rate of cephalothin for Klebsiella pneumoniae was > 40.0%, and the resistance rates of imipenem and meropenem were > 20.0%. The resistance rates of aminoglycosides and quinolones for Methicillin-resistant Staphylococcus in southern Anhui were higher than those in northern Anhui. Conclusions There are significant diffenences in bacterial resistance of different regions in Anhui Province. It is necessary to use antimicrobialagents rationally according to the resistance of bacteria in the local region.
- Bacterial resistance /
- Pathogenic bacteria /
- Antibacterial agents /
- Durg resistance

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表 1 2019年安徽省不同地区主要细菌检出情况[n(%)]

Table 1. The isolated of major bacterials in in different areas of Anhui Province in 2019 [n(%)]

细菌	皖北地区(n=29 152)	皖中地区(n=38 806)	皖南地区(n=24 970)	合计(N=92 928)	χ²值	P值
大肠埃希菌	6 460(22.2)	8 648(22.3)	5 541(22.2)	20 649(22.2)	0.169	0.919
肺炎克雷伯菌	4 549(15.6) ^a	5 735(14.8) ^b	4 286(17.2) ^c	14 570(15.7)	65.601	< 0.001
凝固酶阴性葡萄球菌	3 231(11.1) ^a	4 388(11.3) ^b	2 329(9.3)	9 948(10.7)	68.690	< 0.001
铜绿假单胞菌	2 982(10.2) ^a	3 831(9.9) ^b	2 341(9.4)	9 154(9.8)	11.078	0.004
金黄色葡萄球菌	2 592(8.9) ^a	3 401(8.8) ^b	2 048(8.2)	8 041(8.7)	9.131	0.010
鲍曼不动杆菌	2 088(7.2) ^a	2 953(7.6)	1 969(7.9) ^c	7 010(7.5)	10.499	0.005
阴沟肠杆菌	728(2.5) ^a	1 091(2.8)	719(2.9) ^c	2 538(2.7)	9.012	0.011
屎肠球菌	621(2.1)	1 177(3.0) ^b	522(2.1) ^c	2 320(2.5)	78.867	< 0.001
粪肠球菌	506(1.7) ^a	1 067(2.7) ^b	614(2.4) ^c	2 187(2.4)	76.112	< 0.001
嗜麦芽窄食单胞菌	587(2.0)	914(2.4) ^b	522(2.1) ^c	2 023(2.2)	10.326	0.006
其他	4 808(16.5)	5 601(14.4) ^b	4 079(16.3) ^c	14 488(15.6)	68.057	< 0.001
注：^a皖北和皖南地区差异有统计学意义；^b皖中和皖南地区差异有统计学意义；^c皖中和皖北地区差异有统计学意义。

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表 2 安徽省不同地区MRSA和MRCNS对抗菌药物耐药率(%)

Table 2. Resistance rate of MRSA and MRCNS in different areas of Anhui Province(%)

细菌	MRSA			χ²值	P值	MRCNS			χ²值	P值
细菌	皖北地区(n=2 592)	皖中地区(n=3 401)	皖南地区(n=2 048)	χ²值	P值	皖北地区(n=3 231)	皖中地区(n=4 388)	皖南地区(n=2 329)	χ²值	P值
青霉素G	100.0	100.0	100.0			100.0	100.0	100.0
苯唑西林	100.0	100.0	100.0			100.0	100.0	100.0
庆大霉素	11.4	19.1	27.0	185.060	＜0.001	21.8	27.9	26.4	37.589	＜0.001
利福平	3.6	9.9	5.6	98.891	＜0.001	10.2	9.7	12.3	11.078	0.004
环丙沙星	21.2	26.5	38.4	172.937	＜0.001	51.2	51.7	62.7	90.281	＜0.001
左旋氧氟沙星	20.9	25.9	34.5	109.881	＜0.001	53.2	54.1	63.6	71.122	＜0.001
莫西沙星	21.2	22.0	31.7	84.174	＜0.001	33.2	34.2	41.9	52.081	＜0.001
复方新诺明	15.4	9.5	10.7	52.200	＜0.001	60.9	50.7	45.2	146.749	＜0.001
克林霉素	54.5	47.1	52.5	35.224	＜0.001	44.2	36.2	40.6	50.578	＜0.001
红霉素	78.4	74.4	71.7	28.644	＜0.001	86.9	86.4	85.2	3.477	0.176
利奈唑胺	0.0	0.0	0.0			0.0	0.0	0.0
万古霉素	0.0	0.0	0.0			0.0	0.0	0.0
四环素	34.2	37.0	43.5	43.755	＜0.001	29.7	31.7	33.6	9.716	0.008
呋喃妥因	0.3	0.6	0.0	12.912	0.002	1.7	1.0	2.7	27.685	＜0.001

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表 3 安徽省不同地区大肠埃希菌和肺炎克雷伯菌对抗菌药物耐药率(%)

Table 3. Resistance rate of Escherichia coli and Klebsiella pneumoniae in different areas of Anhui Province(%)

细菌	大肠埃希菌			χ²值	P值	肺炎克雷伯菌			χ²值	P值
细菌	皖北地区(n=6 460)	皖中地区(n=8 648)	皖南地区(n=5 541)	χ²值	P值	皖北地区(n=4 549)	皖中地区(n=5 735)	皖南地区(n=4 286)	χ²值	P值
氨苄西林	86.2	82.9	78.6	121.364	< 0.001	87.3	87.3	89.0	8.262	0.016
头孢哌酮/舒巴坦	8.9	2.0	2.5	487.122	< 0.001	16.2	3.7	1.4	903.028	< 0.001
哌拉西林/他唑巴坦	5.3	3.3	2.6	68.234	< 0.001	19.4	24.3	14.7	142.985	< 0.001
头孢他啶	32.0	27.4	22.6	132.241	< 0.001	29.2	33.9	23.9	118.373	< 0.001
头孢曲松	65.9	59.4	50.4	296.854	< 0.001	38.5	43.6	32.7	122.560	< 0.001
头孢噻肟	61.1	58.1	48.2	219.434	< 0.001	34.8	46.8	41.7	150.503	< 0.001
头孢吡肟	19.9	20.5	17.7	17.493	< 0.001	25.3	29.2	21.8	71.311	< 0.001
氨曲南	44.2	39.3	34.8	110.978	< 0.001	35.1	36.4	27.1	105.573	< 0.001
亚胺培南	1.9	1.6	1.2	9.740	0.008	16.0	21.3	11.2	182.527	< 0.001
美洛培南	1.2	2.0	1.3	18.553	< 0.001	15.0	18.5	20.9	52.980	< 0.001
阿米卡星	5.2	3.2	3.7	40.171	< 0.001	12.7	17.4	10.9	95.619	< 0.001
庆大霉素	46.4	36.3	30.0	354.895	< 0.001	29.0	31.4	21.1	136.744	< 0.001
环丙沙星	61.7	54.0	48.7	209.834	< 0.001	33.9	32.1	20.8	217.871	< 0.001
左旋氧氟沙星	57.3	51.7	44.8	187.059	< 0.001	28.2	28.6	21.1	84.148	< 0.001
复方新诺明	62.0	53.1	48.6	230.092	< 0.001	33.5	31.3	29.9	13.509	0.001
呋喃妥因	2.6	2.4	2.8	2.105	0.349	30.7	35.0	26.5	83.062	< 0.001

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表 4 安徽省不同地区铜绿假单胞菌和鲍曼不动杆菌对抗菌药物耐药率(%)

Table 4. Resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannii in different areas of Anhui Province(%)

细菌	铜绿假单胞菌			χ²值	P值	鲍曼不动杆菌			χ²值	P值
细菌	皖北地区(n=2 982)	皖中地区(n=3 831)	皖南地区(n=2 341)	χ²值	P值	皖北地区(n=2 088)	皖中地区(n=2 953)	皖南地区(n=1 969)	χ²值	P值
氨苄西林	97.9	99.3	96.5	63.013	< 0.001	70.8	76.3	61.0	132.852	< 0.001
头孢哌酮/舒巴坦	20.8	8.0	1.7	551.874	< 0.001	60.4	9.3	3.7	2 378.095	< 0.001
哌拉西林/他唑巴坦	14.6	13.1	11.4	11.629	0.003	71.9	62.5	62.9	55.052	< 0.001
头孢唑啉	98.8	99.6	98.8	13.489	< 0.010	99.5	99.8	99.2	9.688	0.008
头孢他啶	17.3	16.3	15.3	3.894	0.142	70.9	61.2	50.8	172.245	< 0.001
头孢曲松	96.5	98.0	93.4	77.001	< 0.001	65.6	60.3	53.7	62.290	< 0.001
头孢吡肟	14.1	13.1	12.4	3.368	0.186	65.2	58.9	49.6	101.980	< 0.001
氨曲南	26.1	24.9	26.8	2.509	0.285	79.2	77.1	75.3	8.798	0.012
亚胺培南	20.6	22.6	18.1	16.160	< 0.001	65.4	60.7	48.3	131.476	< 0.001
美洛培南	14.6	17.6	12.4	28.707	< 0.001	77.0	62.2	64.5	131.206	< 0.001
阿米卡星	8.4	5.6	4.3	40.360	< 0.001	34.2	36.0	41.0	21.711	< 0.001
庆大霉素	17.1	12.0	9.7	68.495	< 0.001	64.1	55.5	50.4	80.021	< 0.001
环丙沙星	19.7	18.5	15.9	12.999	0.001	74.8	62.2	44.4	397.392	< 0.001
左旋氧氟沙星	19.7	17.8	15.0	19.868	< 0.001	55.4	44.1	37.7	133.442	< 0.001
复方新诺明	90.3	95.1	89.8	65.144	< 0.001	61.7	50.2	42.3	155.363	< 0.001
呋喃妥因	98.1	98.8	94.8	91.847	< 0.001	98.8	99.3	99.0	3.262	0.196

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参考文献(10)

[1]	石荔, 杨玉妹, 汤瑾, 等. 2017年度西藏与上海两家三甲医院细菌与抗菌药物耐药分析[J]. 中华医院感染学杂志, 2020, 30(12): 1816-1821. DOI: 10.11816/cn.ni.2020-190738. Shi L, Yang YM, Tang J, et al. Analysis of the bacterial and antibacteril drug resistance spectrum of the top three hospitals in Tibet and Shanghaiin 2017[J]. Chin J Nosocomiol, 2020, 30(12): 1816-1821. DOI: 10.11816/cn.ni.2020-190738.
[2]	胡付品, 郭燕, 朱德妹, 等. 2019年CHINET三级医院细菌耐药监测[J]. 中国感染与化疗杂志, 2020, 20(3): 233-243. DOI: 10.16718/j.1009-7708.2020.03.001. Hu FP, Guo Y, Zhu DM, et al. CHINET surveillance of bacterial resistance across tertiary hospitals in 2019[J]. Chin J Infect Chemother, 2020, 20(3): 233-243. DOI: 10.16718/j.1009-7708.2020.03.001.
[3]	VJung N, Rieg S. Essentials in the management of S. aureus bloodstream infection[J]. Infection, 2018, 46(4): 441-442. DOI: 10.1007/s15010-018-1130-8.
[4]	吕贞燕, 耿先龙, 王春新. 儿童患者耐甲西林金黄色葡萄球菌的耐药特征及分子流行病学分型[J]. 临床检验杂志, 2018, 36(10): 792-794. DOI: 10.13602/j.cnki.jcls.2018.10.18. Lv ZY, Geng XL, Wang CX. Drug resistance characteristics and moleculr epidemiology of Methicillin-resistant Staphylococcus aureus in children[J]. Chin J Clin Lab Sci, 2018, 36(10): 792-794. DOI: 10.13602/j.cnki.jcls.2018.10.18.
[5]	胡付品, 郭燕, 朱德妹, 等. 2017年CHINET中国细菌耐药性监测[J]. 中国感染与化疗杂志, 2018, 18(3): 241-251. DOI: 10.16178/j.1009-7708.2018.03.001. Hu FP, Guo Y, Zhu DM, et al. Antimicrobial resistance profile of clinical isolates in hospitals across China: report from the CHINET surveillance program, 2017[J]. Chin J Infect Chemother, 2018, 18(3): 241-251. DOI: 10.16178/j.1009-7708.2018.03.001.
[6]	Li SG, Sun SJ, Yang CT, et al. The Changing pattern of population structure of staphylococcus aureus from bacteremia in China from 2013 to 2016: ST239-030-MRSA replaced by ST59-t437[J]. Front Microbiol, 2018, 9: 332. DOI: 10.3389/fmicb.2018.00332.
[7]	Shariati A, Dadashi M, Moghadam MT, et al. Global prevalence and distribution of vancomycin resistant, vancomycin intermediate and heterogeneously vancomycin intermediate Staphylococcus aureus clinical isolates: a systematic review and meta-analysis[J]. Sci Rep, 2020, 10(1): 12689. DOI: 10.1038/s41598-020-69058-z.
[8]	喻华, 徐雪松, 李敏, 等. 肠杆菌目细菌碳青霉烯酶的实验室检测和临床报告规范专家共识[J]. 中国感染与化疗杂志, 2020, 20(6): 671-680. DOI: 10.16178/j.1009-7708.2020.06.015. Yu H, Xu XH, Li M, et al. Consensus statement on laboratory detection and clinical report of carbapenemases among Enterobacterales[J]. Chin J Infect Chemother, 2020, 20(6): 671-680. DOI: 10.16178/j.1009-7708.2020.06.015.
[9]	Durante-Mangoni E, Andini R, Zampino R. Management of carbapenem-resistant Enterobacteriaceae infections[J]. Clin Microbiol Infect, 2019, 25(8): 943-950. DOI: 10:1016/j.cmi.2019.04.013.
[10]	马进宝, 马婷婷, 任斐. 阿米卡星在耐多药结核病治疗中引起耳毒性研究进展[J]. 中国热带医学, 2020(3): 288-290. DOI: 10.13604/j.cnki.46-1064/r.2020.03.21. Ma JB, Ma TT, Ren F. Progress of ototoxicity induced by amikacin in the treatment of multidrug-resistant tuberculosis[J]. China Tropical Medicine, 2020, 20(3): 288-290. DOI: 10.13604/j.cnki.46-1064/r.2020.03.21.