检索历史 清除

目的:了解社区、医疗保健相关性及院内感染细菌的分布和耐药性差异。方法:收集2019年1月至2023年12月西安市第一医院不同临床标本的分离细菌，根据感染场所分为社区获得性感染（community-acquired infection，CAI）组、医疗保健相关性感染（healthcare-associated infection，HCAI）组和医院获得性感染（hospital-acquired infection，HAI）组，比较三组细菌的分布和耐药性差异。采用SPSS 22.0统计软件对数据进行分析。结果:共收集细菌9 762株，CAI组2 258株（23.1%），HCAI组763株（7.8%），HAI组6 741株（69.1%）。HCAI组大肠埃希菌检出率低于CAI组，高于HAI组（ χ2=106.335和69.603， P值均<0.001）；铜绿假单胞菌和鲍曼不动杆菌检出率均高于CAI组（ χ2=35.749和65.098， P值均<0.001），低于HAI组（ χ2=26.350和115.885， P值均<0.001）；金黄色葡萄球菌检出率高于CAI和HAI组（ χ2=5.745和13.992， P值均<0.05）。HCAI组耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus， MRSA）检出率低于HAI组（ χ2=69.005， P<0.001），MRSA对左氧氟沙星和莫西沙星的耐药率均高于CAI组（ χ2=13.634和13.083， P值均<0.001），低于HAI组（ χ2=17.927和21.937， P值均<0.001）。HCAI组大肠埃希菌对哌拉西林/他唑巴坦、头孢曲松、头孢他啶、头孢哌酮/舒巴坦、环丙沙星及左氧氟沙星的耐药率均高于CAI组，对头孢哌酮/舒巴坦、美罗培南、亚胺培南及阿米卡星的耐药率均低于HAI组（ P值均<0.05）。除呋喃妥因外，HCAI组肺炎克雷伯菌对其他抗菌药物的耐药率均高于CAI组，而低于HAI组（ P值均<0.01）。HCAI组铜绿假单胞菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、美罗培南和亚胺培南的耐药率均高于CAI组（ χ2=14.107、14.819、16.822和15.998， P值均<0.001），低于HAI组（ χ2=7.821、4.671、18.070和17.552， P值均<0.05）。HCAI组鲍曼不动杆菌对哌拉西林/他唑巴坦、美罗培南、亚胺培南、环丙沙星和左氧氟沙星的耐药率均低于HAI组（ χ2=32.263、31.526、42.417、25.277和6.798， P值均<0.01）。 结论:HCAI组在细菌构成和耐药性方面，与CAI组和HAI组均存在一定差异；临床工作中应区分感染场所，开展精细化耐药性监测，以更好地指导抗菌药物合理使用。

Objective:To investigate the bacterial isolate distribution and differences of antimicrobial resistance among community-acquired infection，healthcare-associated infection and hospital-acquired infection.Methods:Bacterial isolates from clinical specimens were collected in Xi'an No.1 Hospital between January 2019 and December 2023 and categorized into community-acquired infection（CAI），healthcare-associated infection（HCAI）and hospital-acquired infection（HAI）. The bacterial distribution and antimicrobial resistance differences among the three groups were compared. Data were analyzed with SPSS 22.0 statistical software.Results:A total of 9 762 bacterial strains were collected：2 258 strains（23.1%）in CAI group，763 strains（7.8%）in HCAI group and 6 741 strains（69.1%）in HAI group. In HCAI group，the detection rate of Escherichia coli was lower than that in CAI group，and higher than that in HAI group（ χ2=106.335 and 69.603，both P<0.001）. The detection rates of Pseudomonas aeruginosa and Acinetobacter baumannii in HCAI group were higher than those in CAI group（ χ2=35.749 and 65.098，both P<0.001），and lower than those in HAI group（ χ2=26.350 and 115.885，both P<0.001）. The detection rate of Staphylococcus aureus in HCAI group was higher than that in CAI and HAI groups（ χ2=5.745 and 13.992，both P<0.05）. In HCAI group，the detection rate of methicillin-resistant Staphylococcus aureus（MRSA）was lower than that in HAI group（ χ2=69.005， P<0.001）；and MRSA in HCAI demonstrated higher resistance to levofloxacin and moxifloxacin than that in CAI group（ χ2=13.634 and 13.083，both P<0.001），and lower than that in HAI group（ χ2=17.927 and 21.937，both P<0.001）. The resistance rates of Escherichia coli to piperacillin/tazobactam，ceftriaxone，ceftazidime，cefoperazone/sulbactam，ciprofloxacin and levofloxacin in HCAI group were higher than those in CAI group，and the resistance rates to cefoperazone/sulbactam，meropenem，imipenem and amikacin in HCAI group were lower than those in HAI group（all P<0.05）. For Klebsiella pneumoniae，the resistance rate in HCAI group was higher than that in CAI group and lower than that in HAI group to all antibacterial agents，except for nitrofurantoin（all P<0.01）. For Pseudomonas aeruginosa，the resistance rate in HCAI group was higher than that in CAI group（ χ2=14.107，14.819，16.822 and 15.998，all P<0.001）and lower than that in HAI group（ χ2=7.821，4.671，18.070 and 17.552，all P<0.05）to piperacillin/tazobactam，cefoperazone/sulbactam，meropenem and imipenem. Acinetobacter baumannii in HCAI group demonstrated lower resistance to piperacillin/tazobactam，meropenem，imipenem，ciprofloxacin and levofloxacin than that in HAI group（ χ2=32.263，31.526，42.417，25.277 and 6.798，all P<0.01）. Conclusion:The bacterial distribution and antimicrobial resistance in HCAI group are different from CAI and HAI groups. It is recommended to carry out precise antibiotic resistance surveillance in different categories of infections for rational antibiotic use.