目的:分析大理大学第一附属医院近三年奇异变形杆菌临床分布及耐药情况,为临床诊断及合理用药提供理论依据。方法:收集2018年1月~2020年12月我院153株奇异变形杆菌院内感染患者的临床数据,分析其临床分布及耐药情况。结果:共分离153株奇异变形杆菌,标本主要来源于分泌物及中段尿(占72.40%),科室主要来源于泌尿科及烧伤整形科(占34.5%),年龄≤1岁的患儿占0%,2~18岁(含18岁)占1.8%,18~60岁(含60岁)患者占57.30%,>60岁的患者占40.90%。奇异变形杆菌对呋喃妥因、四环素的耐药率高(97.44%~100.00%),对美罗培南的耐药率低(0.00%~2.20%),未发现对阿米卡星耐药的奇异变形杆菌。结论:奇异变形杆菌主要分离于分泌物及中段尿,感染病例主要分布于泌尿科及烧伤整形科,年龄18~60岁(含60岁)是感染的主要年龄段,奇异变形杆菌对美诺培南、氨曲南、头孢吡肟、头孢美唑、头孢西丁、头孢西丁的耐药率较低且处于相对稳定水平,因此抗菌药物可作为临床治疗的抗感染药物。 Objective: To analyze the clinical distribution and drug resistance of Proteus mirabilis in the First Affiliated Hospital of Dali University in the past three years to provide theoretical basis for clinical diagnosis and rational drug use. Methods: The clinical data of 153 nosocomial infections of Proteus mirabilis in our hospital from January 2018 to December 2020 were analyzed for their clinical distribution and drug resistance. Results: A total of 153 strains of Proteus mirabilis were isolated, and the specimens mainly originated from secretions and middle urine (72.40%), the departments mainly originated from urology and burn orthopedics (34.5%), children aged ≤1 year accounted for 0%, 2 to 18 years (including 18 years) accounted for 1.8%, patients aged 18 to 60 years (including 60 years) accounted for 57.30%, patients aged >60 years accounted for 40.90%, high resistance rate of Proteus mirabilis to FT and TE (97.44%~100.00%), low resistance rate to MPN (0.00%~2.20%), and no Proteus mirabilis resistant to AN were found. Conclusions: Proteus mirabilis was mainly isolated from secretions and middle urine, the infection cases were mainly distributed in urology and burn orthopaedics, aged 18~60 years (including 60 years) was the main age group of infection, the resistance rate of Proteus mirabilis to menopenem, aminotransferase, cefepime, cefmetazole, cefoxitin and cefoxitin was low and at a relatively stable level, therefore the antibacterial drugs could be used as clinical treatment for anti-infective drugs.
目的:分析大理大学第一附属医院近三年奇异变形杆菌临床分布及耐药情况,为临床诊断及合理用药提供理论依据。方法:收集2018年1月~2020年12月我院153株奇异变形杆菌院内感染患者的临床数据,分析其临床分布及耐药情况。结果:共分离153株奇异变形杆菌,标本主要来源于分泌物及中段尿(占72.40%),科室主要来源于泌尿科及烧伤整形科(占34.5%),年龄≤1岁的患儿占0%,2~18岁(含18岁)占1.8%,18~60岁(含60岁)患者占57.30%,>60岁的患者占40.90%。奇异变形杆菌对呋喃妥因、四环素的耐药率高(97.44%~100.00%),对美罗培南的耐药率低(0.00%~2.20%),未发现对阿米卡星耐药的奇异变形杆菌。结论:奇异变形杆菌主要分离于分泌物及中段尿,感染病例主要分布于泌尿科及烧伤整形科,年龄18~60岁(含60岁)是感染的主要年龄段,奇异变形杆菌对美诺培南、氨曲南、头孢吡肟、头孢美唑、头孢西丁、头孢西丁的耐药率较低且处于相对稳定水平,因此抗菌药物可作为临床治疗的抗感染药物。
奇异变形杆菌,临床分布,耐药性
Shaobo Tang, Zhimin Li, Jie Zhang, Jiaqi Xu, Li Wang*
Clinical Medical College, Dali University, Dali Yunnan
Received: Mar. 1st, 2022; accepted: Mar. 25th, 2022; published: Apr. 6th, 2022
Objective: To analyze the clinical distribution and drug resistance of Proteus mirabilis in the First Affiliated Hospital of Dali University in the past three years to provide theoretical basis for clinical diagnosis and rational drug use. Methods: The clinical data of 153 nosocomial infections of Proteus mirabilis in our hospital from January 2018 to December 2020 were analyzed for their clinical distribution and drug resistance. Results: A total of 153 strains of Proteus mirabilis were isolated, and the specimens mainly originated from secretions and middle urine (72.40%), the departments mainly originated from urology and burn orthopedics (34.5%), children aged ≤1 year accounted for 0%, 2 to 18 years (including 18 years) accounted for 1.8%, patients aged 18 to 60 years (including 60 years) accounted for 57.30%, patients aged >60 years accounted for 40.90%, high resistance rate of Proteus mirabilis to FT and TE (97.44%~100.00%), low resistance rate to MPN (0.00%~2.20%), and no Proteus mirabilis resistant to AN were found. Conclusions: Proteus mirabilis was mainly isolated from secretions and middle urine, the infection cases were mainly distributed in urology and burn orthopaedics, aged 18~60 years (including 60 years) was the main age group of infection, the resistance rate of Proteus mirabilis to menopenem, aminotransferase, cefepime, cefmetazole, cefoxitin and cefoxitin was low and at a relatively stable level, therefore the antibacterial drugs could be used as clinical treatment for anti-infective drugs.
Keywords:Proteus mirabilis, Clinical Distribution, Drug Resistance
Copyright © 2022 by author(s) and Hans Publishers Inc.
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变形杆菌属肠杆菌科,包括普通变形杆菌,奇异变形杆菌,产黏变形杆菌,潘氏变形杆菌,以及豪氏变形杆菌五个种 [
收集2018年1月~2020年12月大理大学第一附属医院住院患者的分泌物、口痰、脓液、中段尿等标本并排除重复标本,共分离出153株奇异变形杆菌。
普通培养箱、CO2培养箱、全自动血液培养仪、全自动微生物鉴定与药敏分析仪(VITEK-2 Compact)、血琼脂平板和GP68奇异变形杆菌药敏卡,K-B法药敏纸片。
细菌分离按《全国临床检验操作规程》第4版操作,采集的标本在无菌条件下分别划线接种血液琼脂平板,经37℃恒温过夜培养,挑取形态特征一致的菌落重新划线接种于血液琼脂平板进行纯化,挑取菌落进行革兰氏染色镜检,并将菌种接种于TSB培养液中备用。
采用SPSS.20软件对药敏数据进行数据录入、统计和分析,计算菌株的数量和耐药率,以P < 0.05为差异具有统计学意义。
去除相同标本来源后,2018~2020年我院共分离出153株奇异变形杆菌,其中分离自分泌物共57株(37.20%),中段尿54株(35.20%),口痰23株(15.00%),灌洗液6株(3.90%),脓液4株(2.60%),全血3株(1.90%),腹水2株(1.30%),咽拭子2株(1.30%),白带1株(0.60%),穿刺液1株(0.60%)。见表1。
标本来源 | 菌株数/株 | 构成比(%) |
---|---|---|
分泌物 | 57 | 37.20 |
中段尿 | 54 | 35.20 |
口痰 | 23 | 15.00 |
灌洗液 | 6 | 3.90 |
脓液 | 4 | 2.60 |
全血 | 3 | 1.90 |
腹水 | 2 | 1.30 |
咽拭子 | 2 | 1.30 |
白带 | 1 | 0.60 |
穿刺液 | 1 | 0.60 |
表1. 2018~2020年患者奇异变形杆菌标本来源分布(n = 153)
科室来源以泌尿科,烧伤整形科,创伤骨科,呼吸科,肾内科,皮肤科为主,分别为29株(18.9%),24株(15.6%),8株(5.2%),8株(5.2%),8株(5.2%),8株(5.2%),见表2。
科室 | 菌株数/株 | 构成比(%) |
---|---|---|
泌尿科 | 29 | 18.90 |
烧伤整形科 | 24 | 15.60 |
创伤骨科 | 8 | 5.20 |
呼吸科 | 8 | 5.20 |
肾内科 | 8 | 5.20 |
皮肤科 | 8 | 5.20 |
ICU | 7 | 4.50 |
妇科 | 7 | 4.50 |
老年病科 | 6 | 3.9 |
普通外科 | 6 | 3.9 |
产科 | 4 | 2.60 |
关节外科 | 4 | 2.60 |
儿科 | 3 | 1.90 |
急诊ICU | 3 | 1.90 |
内分泌科 | 3 | 1.90 |
神经外科 | 3 | 1.90 |
消化内科 | 3 | 1.90 |
血液科 | 3 | 1.90 |
其他科室 | 11 | 7.10 |
表2. 2018~2020年患者奇异变形杆菌科室分布(n = 153)
分离出的153株奇异变形杆菌主要来源于18~60岁(含60岁)和>60岁患者,其中18~60岁(含60岁)患者有84株(57.30%),>60岁患者有66株(40.90%),见表3。
年龄/岁 | 菌株数/株 | 构成比(%) |
---|---|---|
≤1 | 0 | 0 |
1 < 年龄 ≤ 18 | 3 | 1.80 |
18 < 年龄 ≤ 60 | 84 | 57.30 |
>60 | 66 | 40.90 |
表3. 2018~2020年患者奇异变形杆菌年龄分布(n = 153)
153株奇异变形杆菌的性别构成比为男68人(44.4%),女85人(55.5%)。见表4。
性别 | 菌株数/株 | 构成比(%) |
---|---|---|
男 | 68 | 44.40 |
女 | 85 | 55.50 |
表4. 2018~2020年患者奇异变形杆菌性别比(n = 153)
抗菌药物 | 2018 (n = 65) | 2019 (n = 43) | 2020 (n = 45) | p |
---|---|---|---|---|
氨苄西林 | 44 (67.60) | 28 (65.10) | 27 (11.05) | 0.707 |
阿莫西林/克拉维酸 | 0 (0.00) | 13 (33.33) | 5 (11.10) | <0.001 |
阿米卡星 | 0 (0.00) | 0 (0.00) | 0 (0.00) | - |
氨曲南 | 7 (10.70) | 5 (11.60) | 2 (4.40) | 0.423 |
环丙沙星 | 36 (55.30) | 25 (58.10) | 28 (63.63) | 0.775 |
头孢曲松 | 26 (40.00) | 21 (48.80) | 16 (35.50) | 0.435 |
呋喃妥因 | 63 (96.90) | 40 (95.24) | 38 (97.44) | 0.055 |
头孢吡肟 | 6 (9.20) | 7 (16.20) | 2 (4.40) | 0.172 |
庆大霉素 | 15 (23.00) | 12 (27.90) | 10 (25.64) | 0.793 |
左氧氟沙星 | 14 (21.50) | 21 (48.80) | 16 (35.50) | 0.012 |
美诺培南 | 1 (1.50) | 0 (0.00) | 1 (2.20) | 0.641 |
哌拉西林 | 10 (15.30) | 27 (64.29) | 19 (48.72) | <0.001 |
头孢唑林 | 45 (69.20) | 32 (74.4) | 31 (68.80) | 0.809 |
头孢他啶 | 2 (3.28) | 3 (6.90) | 0 (0.00) | 0.183 |
四环素 | 55 (100.00) | 40 (95.24) | 38 (97.44) | 0.085 |
厄他培南 | 2 (3.17) | 0 (0.00) | 1 (2.20) | 0.523 |
头孢哌酮/舒巴坦 | 2 (3.17) | 1 (2.30) | 0 (0.00) | 0.509 |
头孢美唑 | 2 (3.17) | 0 (0.00) | 4 (9.09) | 0.090 |
头孢噻肟 | 19 (31.67) | 20 (46.50) | 16 (36.36) | 0.186 |
头孢西丁 | 3 (4.84) | 4 (9.30) | 3 (6.60) | 0.627 |
头孢呋辛 | 25 (41.67) | 20 (46.50) | 17 (38.64) | 0.639 |
头孢唑肟 | 9 (15.52) | 5 (11.60) | 4 (8.80) | 0.730 |
氨苄西林/舒巴坦 | 20 (32.79) | 18 (41.80) | 10 (33.33) | 0.138 |
表5. 2018~2020年患者奇异变形杆菌耐药性情况[n (%)]
2018~2020年奇异变形杆菌对呋喃妥因、四环素的耐药率3年均处于较高水平,最高分别为97.44%和100.00%;对环丙沙星的耐药率逐渐升高,2018年最低(55.30%),2020年最高(63.63%);对哌拉西林的耐药率波动性较大,2018~2020年间在15.30%~64.29%之间波动;对氨苄西林的耐药率由2018年的67.60%逐年降低,到2020年为11.05%;对美诺培南、头孢他啶、厄他培南、头孢哌酮/舒巴坦的耐药率较低,三年内均在6.90%内波动;未发现对阿米卡星耐药的奇异变形杆菌。对阿莫西林/克拉维酸、左氧氟沙星、哌拉西林各年度耐药率比较差异有统计学意义(P < 0.05),其余药物各年度耐药率比较差异均无统计学意义(P > 0.05)。见表5。
本次研究共分离到153株奇异变形杆菌,从标本来源看,奇异变形杆菌主要来源于分泌物标本、中段尿标本和口痰标本,共占87.4%,这与多数研究一致 [
近年来,随着抗菌药物的大量使用,耐药奇异变形杆菌的出现严重威胁着人们的生命健康安全,因此临床上应时刻关注奇异变形杆菌的分布特点及耐药情况,这对临床治疗及药物使用有着极大的促进作用。
云南省教育厅科研基金研究生项目(2022Y846)。
汤绍波,李志敏,张 杰,徐佳琪,王 黎. 2018~2020年大理市某医院奇异变形杆菌临床分布及耐药性分析Clinical Distribution and Drug Resistance Analysis of Proteus mirabilis in a Hospital in Dali City, 2018~2020[J]. 临床医学进展, 2022, 12(04): 2437-2443. https://doi.org/10.12677/ACM.2022.124352