| ObjectiveTo effectively treat bacterial infections and slow down the emergence of multidrug-resistant strains.Our study investigated the clinical distribution and multidrug resistance of major bacterial pathogens detected in clinical specimens from a tertiary hospital in Zhengzhou,Henan Province from 2017 to 2020,wishing to provide basis for clinical rational application of antibiotics in hospital.Methods(1)The distribution of pathogens in different specimens’source,department,age and gender in a tertiary hospital from January 1,2017 to December 31,2020 were collected Retrospectively.And we eliminated duplicate data.(2)We Identified bacteria by Automatic Bacterial Identification Drug Sensitivity Analyzer and Automatic Rapid Microbial Mass Spectrometry Detection System,and tested drug sensitivity by instrument method,K-B method and E-test method.(3)We Analyzed detection rates and distribution of different pathogens in different specimens’ source,department,age,gender,and multi-drug resistance of major gram positive bacteria and gram negative bacteria in each year.(4)We Established drug sensitivity database and analyzed data by WHONET5.6.Using chi-square test and Fisher exact test to compare drug resistance rates and differences among years through SPSS22.0 software.P<0.05 was considered statistically significant.Results(1)Detection of pathogenic bacteriaFrom January 1,2017 to December 31,2020,a total of 90940 strains were detected,including 62380(68.59%)Gram-negative bacteria,22644(24.90%)Gram-negative bacteria and 5916(6.51%)fungi.Gram-negative bacteria mainly included Escherichia coli(17.17%),Klebsiella pneumoniae(16.52%),Acinetobacter baumannii(9.93%)and Pseudomonas aeruginosa(9.65%).Gram-negative bacteria mainly included Staphylococcus aureus(7.09%),enterococcus faecium(4.49%),enterococcus faecalis(3.67%)and staphylococcus epidermidis(2.36%).(2)The source and distribution of pathogenic bacteriaThe main source of specimens were sputum specimens(24.75%),urine specimens(23.38%),secretions specimens(12.44%),blood specimens(11.39%),lavage fluid specimens(7.55%)and pus specimens(6.07%).The proportion of sputum specimens decreased year by year and the proportion of sputum specimens increased year by year.(3)Distribution and multi-drug resistance of pathogenic bacteria in different departmentsPathogens mainly came from Department of Urology(12.83%),comprehensive ICU(7.60%)and Respiratory ICU(7.33%).The highest rate of multi-drug resistance was renal surgery(70.36%),followed by neonatology(70.35%),comprehensive ICU(68.55%)and ICU(68.06%).(4)The distribution and multi-drug resistance of pathogens in patients of different agesPathogens were mainly distributed in the elderly.The highest percentage was in the 60-69 year group(22.98%),followed by the 50-59 age group(21.25%).The highest average multi-drug resistance rate in four years was 80-89 age group(62.55%),followed by over 90 age group(62.50%)and 70-79 age group(61.39%).The multidrug resistance rate of 30-49 age group increased year by year.(5)Distribution of pathogenic bacteria and multi-drug resistance in patients of different gendersThe detection rate of pathogens in male patients(57.78%)was higher than that in female patients(42.22%).There was no significant change in the multi-drug resistance rate of male patients from 2017 to 2020.The multi-drug resistance rate of women increased year by year from 2017(56.02%)to 2020(61.56%).(6)Drug resistance of Klebsiella pneumoniaeKlebsiella pneumoniae was most sensitive to polymyxin B,and the resistance rates from 2017 to 2020 were 0.52%,0.46%,0 and 0.The second was tigecycline,and the drug resistance rates were 2.09%,3.30%,2.10%and 6.59%,respectively.The sensitivity to ampicillin was the lowest,almost all four-year resistance rates were nearly 100.00%.Ciprofloxacin,levofloxacin,cefepime,and minocycline’drug resistance rates increased,while the drug resistance rate of sulfamethoxazole decreased year by year.(7)Drug resistance of Escherichia coliEscherichia coli was most sensitive to tigecycline and polymyxin B.It was highly sensitive to nitrofurantoin,meropenem,imipenem,ertapenem,amikacin,cefotetan and piperacillin/tazobactam,and the resistance rates were between 0.92%and 11.65%.The sensitivity to ampicillin was the worst,and the drug resistance rates were above 90.00%.The four-year drug resistance rates of cefazolin and ciprofloxacin showed an overall upward trend.(8)Drug resistance of Acinetobacter baumanniiAcinetobacter baumannii was most sensitive to polymyxin B,and the resistance rates from 2017 to 2020 were 0.55%,0.36%,0.05%and 0.The second was tigecycline,and the drug resistance rates were 4.60%,1.69%,0.67%and 3.20%,respectively.The sensitivity of other antibiotics was poor,and the drug resistance rates were above 60.00%.Levofloxacin and ampicillin/sulbactam’resistance rates showed an increasing trend.(9)Drug resistance of Pseudomonas aeruginosaPseudomonas aeruginosa was most sensitive to polymyxin B,and the resistance rates from 2017 to 2020 were 1.53%,0.10%,0.15%and 0.The second was amikacin,and the drug resistance rates were 10.83%,10.96%,15.35%and 13.79%,respectively.Amoxicillin/clavulanic acid,chloramphenicol and cefotaxime were 100.00%resistant.The four-year drug resistance rates of piperacillin/tazobactam,aztreonam,minocycline,doxycycline,cefoperazone/sulbactam and polymyxin B showed a downward trend.(10)Drug resistance of Staphylococcus aureusStaphylococcus aureus was completely sensitive to vancomycin,linezolid,tigecycline,minocycline and doxycycline.It was highly sensitive to quinupristin/dalfopristin and nitrofurantoin with the resistance rate lower than 1.00%.It was sensitive to quinolones with drug resistance rate between 14.78%and 22.42%.It was 100.00%resistant to ampicillin and highly resistant to penicillin G with the resistance rate above 96.00%.The resistance rate to clarithromycin and azithromycin showed an increasing trend.(11)Drug resistance of Staphylococcus epidermidisStaphylococcus epidermidis was completely sensitive to doxycycline,tigecycline and minocycline.It was highly sensitive to linezolid,vancomycin,nitrofurantoin,teicoplanin,quinupristin/dalfopristin,with resistance rates not exceeding 1.00%.It was 100.00%resistant to imipenem,meropenem,ceftriaxone,cefotaxime,cefepime and ampicillin.The resistance rates to clarithromycin,azithromycin,moxifloxacin,gentamicin and levofloxacin showed an increasing trend.(12)Drug resistance of Enterococcus faecalisEnterococcus faecalis was completely sensitive to tigecycline,chloramphenicol and imipenem.It was high sensitivity to vancomycin,and the resistance rates were between 0.09%and 0.50%.It was sensitive to nitrofurantoin,linezolid,ampicillin and penicillin G,and the drug resistance rates were between 1.07%and 5.92%.It was 100.00%resistant to clindamycin,sulfamethoxazole,cefazolin,tobramycin,amikacin,and oxacillin.It’s resistance rates to moxifloxacin,levofloxacin and ciprofloxacin increased year by year.(13)Drug resistance of Enterococcus faecalisEnterococcus faecium was completely sensitive to teicoplanin,chloramphenicol,tigecycline and minocycline.It was highly sensitive to vancomycin and linezolid with the drug resistance rate between 0.07%and 0.57%.It was 100.00%resistant to Clinomycin,sulfamethoxazole,imipenem,tobramycin,amikacin.It showed low sensitivity to levofloxacin,ciprofloxacin,erythromycin,ampicillin and penicillin G,and the drug resistance rates were between 90.28%and 94.94%.The overall resistance rates to nitrofurantoin showed an increasing trend.Conclusions(1)The pathogens isolated in hospital from 2017 to 2020 were mainly Gramnegative bacteria.The specimens for examination mainly came from sputum,urine and secretion specimens.The pathogens are mainly distributed in urology,comprehensive ICU and respiratory ICU.It is necessary to strengthen the sterilization and management of antibiotics in ICU departments.(2)The detection rates of pathogens were higher in middle-aged and elderly patients,and increased slowly.The multi-drug resistance rate of elderly patients was also higher.The detection rate of pathogens in female patients was lower than that in male patients.Female patients’multi-drug resistance rate increased year by year.More attention should be paid to the standardized use of antibiotics in elderly patients and female patients.(3)The monitoring results showed that Klebsiella pneumoniae,Escherichia coli,Acinetobacter baumannii and Pseudomonas aeruginosa belonging to Gram-negative bacteria were almost inactive to ampicillin and highly sensitive to polymyxin B.Except Pseudomonas aeruginosa,they were highly sensitive to tigecycline and highly resistant to cephalosporins and quinolones.Klebsiella pneumoniae and Acinetobacter baumannii were highly resistant to carbapenem antibiotics.All their resistance rates to cefoperazone/sulbactam showed a downward trend.(4)Staphylococcus aureus,Staphylococcus epidermidis,Enterococcus faecalis and Enterococcus faecium belonging to Gram-positive bacteria were highly sensitive to vancomycin,linezolid,tigecycline and minocycline,and highly resistant to erythromycin and clindamycin.Except Enterococcus faecalis,they were almost inactivated to ampicillin,and highly resistant to penicillin,highly sensitive to quinupristin/dalfopristin and nitrofurantoin.The resistance rate to tetracycline decreased. |
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