您的位置:山东大学 -> 科技期刊社 -> 《山东大学学报(医学版)》

山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (12): 88-93.doi: 10.6040/j.issn.1671-7554.0.2022.0752

• • 上一篇    

2016—2021年山东省11个地区摩根摩根菌的抗生素耐药变迁

孙薏丰1,17,李伟1,孙士营2,顾安曼3,谭胜楠4,傅勋业5,王海志6,纪建粉7,关于旺8,吴向前9,贺志成10,温招阳11,于尚嘉12,李世易13,刘兴红14,陈英15,王婷婷16,孙允东17   

  1. 1.山东大学齐鲁医院检验科, 山东 济南 250012;2.山东大学齐鲁医院青岛院区检验科, 山东 青岛 266035;3.山东第一医科大学附属省立医院感染管理办公室, 山东 济南 250021;4.乳山市人民医院检验科, 山东 乳山 264599;5.淄博市中西医结合医院检验科, 山东 淄博 255020;6.潍坊市第二人民医院检验科, 山东 潍坊 261041;7.临沭县人民医院检验科, 山东 临沭 276799;8.梁山县人民医院检验科, 山东 梁山 272699;9.北大医疗鲁中医院检验科, 山东 淄博 255499;10.北大医疗鲁中医院骨外二科, 山东 淄博 255499;11.滨州医学院第一临床医院检验科, 山东 滨州 256699;12.栖霞市人民医院检验科, 山东 栖霞 265399;13.荣成市中医院检验科, 山东 荣成 264399;14.招远市人民医院检验科, 山东 招远 265499;15.日照市人民医院检验科, 山东 日照 276827;16.宁津县人民医院检验科, 山东 宁津 253499;17.山东大学齐鲁医学院基础医学院病原生物学系, 山东 济南 250012
  • 发布日期:2022-12-01
  • 通讯作者: 孙允东. E-mail:syd@sdu.edu.cn
  • 基金资助:
    国家自然科学基金(82172313);山东省重点研发计划(2019GSF108130);山东省重大创新项目(2021GXGC011305)

Changes of antibiotic resistance rates of Morganella morganii in 11 regions of Shandong Province from 2016 to 2021

SUN Yifeng1,17, LI Wei1, SUN Shiying2, GU Anman3, TAN Shengnan4, FU Xunye5, WANG Haizhi6, JI Jianfen7, GUAN Yuwang8, WU Xiangqian9, HE Zhicheng10, WEN Zhaoyang11, YU Shangjia12, LI Shiyi13, LIU Xinghong14, CHEN Ying15, WANG Tingting16, SUN Yundong17   

  1. 1. Department of Clinical Laboratory, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. Department of Clinical Laboratory, Qilu Hospital(Qingdao)of Shandong University, Cheeloo College of Medicine, Qingdao 266035, Shandong, China;
    3. Department of Infection Management Office, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China;
    4. Department of Clinical Laboratory, Rushan Peoples Hospital, Rushan 264599, Shandong, China;
    5. Department of Clinical Laboratory, Zibo Integrative Medicine Hospital, Zibo 255020, Shandong, China;
    6. Department of Clinical Laboratory, Weifang No.2 Peoples Hospital, Weifang 261041, Shandong, China;
    7. Department of Clinical Laboratory, Linshu County Peoples Hospital, Linshu 276799, Shandong, China;
    8. Department of Clinical Laboratory, Liangshan County Peoples Hospital, Liangshan 272699, Shandong, China;
    9. Department of Clinical Laboratory, PKU Care Luzhong Hospital, Zibo 255499, Shandong, China;
    10. Department of Orthopedic Surgery, PKU Care Luzhong Hospital, Zibo 255499, Shandong, China;
    11. Department of Clinical Laboratory, The First School Clinical Medicine of Binzhou Medical University, Binzhou 256699, Shandong, China;
    12. Department of Clinical Laboratory, Qixia City Peoples Hospital, Qixia 265399, Shandong, China;
    13. Department of Clinical Laboratory, Rongcheng Hospital of Traditional Chinese Medicine, Rongcheng 264399, Shandong, China;
    14. Department of Clinical Laboratory, The Peoples Hospital of Zhaoyuan City, Zhaoyuan 265499, Shandong, China;
    15. Department of Clinical Laboratory, Peoples Hospital of Rizhao, Rizhao 276827, Shandong, China;
    16. Department of Clinical Laboratory, Ningjin County Peoples Hospital, Ningjin 253499, Shandong, China;
    17. Department of Pathogenic Biology, School of Basic Medical Science, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
  • Published:2022-12-01

摘要: 目的 分析山东省2016—2021年摩根摩根菌的抗生素耐药变迁趋势,了解摩根摩根菌耐药特征,为临床合理用药提供数据支持。 方法 回顾性分析2016—2021年山东省11个地区14家医院838株摩根摩根菌临床分离株的耐药数据。根据分离标本的组织来源不同,将摩根摩根菌分为泌尿系统(UT)组(n=271)、呼吸系统(RT)组(n=161)、皮肤软组织(SST)组(n=294)和其他组(n=112)。采用线性回归方法分析耐药率随时间的变化。采用Pearson χ2检验或Fisher精确检验分析组间差异。 结果 2016—2021年山东省摩根摩根菌对氨苄西林/舒巴坦的耐药率呈线性下降趋势(P=0.005),对头孢哌酮/舒巴坦的耐药率呈线性上升趋势(P=0.006)。20172020年山东省摩根摩根菌对左氧氟沙星的耐药率均高于全国水平(P<0.05)。UT组摩根摩根菌对阿米卡星、庆大霉素、妥布霉素、氨曲南、氨苄西林/舒巴坦、哌拉西林/他唑巴坦、复方新诺明、环丙沙星、左氧氟沙星的耐药率高于RT组(P均<0.05);对庆大霉素、头孢吡肟、氨曲南、哌拉西林/他唑巴坦、环丙沙星、左氧氟沙星的耐药率高于SST组(P均<0.05)。 结论 山东省摩根摩根菌对多种抗生素的耐药性普遍较高,其中对喹诺酮类抗生素的耐药性最高,各级医疗机构应加强对喹诺酮类药物的合理应用。推荐使用头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢吡肟和阿米卡星作为治疗摩根摩根菌感染的一线药物。

关键词: 摩根摩根菌, 抗生素耐药, 氨基糖苷类, 喹诺酮类, 合理用药, 山东省

Abstract: Objective To investigate the changing trend of antibiotic resistance of Morganella morganii in Shandong Province from 2016 to 2021, and to explore the drug resistance characteristics, in order to provide data support for rational clinical use. Methods The drug resistance data of 838 clinical isolates of Morganella morganii from 14 hospitals in 11 regions of Shandong Province from 2016 to 2021 were retrospectively analyzed. According to the tissue sources, the isolated specimens were divided into urinary tract(UT)group(n=271), respiratory tract(RT)group(n=161), skin soft tissue(SST)group(n=294)and other groups(n=112). Linear regression was used to analyze the trend of drug resistance, and Pearson χ2 or Fishers exact test were used to analyze the differences among groups. Results From 2016 to 2021, the resistance rate of Morganella morganii to ampicillin/sulbactam showed a linear downward trend(P=0.005), while the resistance rate to cefoperazone/sulbactam showed a linear upward trend(P=0.006). The drug resistance rate of Morganella morganii to levofloxacin in Shandong Province from 2017 to 2020 was higher than that of the national level(P<0.05). The drug resistance rates of Morganella morganii in the UT group to amikacin, gentamicin, tobramycin, aztreonam, ampicillin/sulbactam, piperacillin/tazobactam, compound sulfamethoxazole, ciprofloxacin and levofloxacin were higher than those in RT group(all P<0.05). The resistance rates of Morganella morganii to gentamicin, cefepime, aztreonam, piperacillin/tazobactam, ciprofloxacin and levofloxacin in the UT group were higher than those in the SST group(all P<0.05). Conclusion In Shandong Province, the drug resistance of Morganella morganii to a variety of antibiotics is generally high, and the drug resistance to quinolones is the highest. Medical institutions at all levels should strengthen the rational application of quinolones. The use of cefoperazone/sulbactam, piperacillin/tazobactam, cefepime, and amikacin as first-line agents for the treatment of Morganella morganii infection is recommended.

Key words: Morganella morganii, Antibiotic resistance, Aminoglycosides, Quinolones, Rational drug use, Shandong Province

中图分类号: 

  • R446.5
[1] OHara CM, Brenner FW, Miller JM. Classification, identification, and clinical significance of Proteus, Providencia, and Morganella [J]. Clin Microbiol Rev, 2000,13(4): 534-546.
[2] Pham B, Denslow A, Mikhael M, et al. A case of an extremely low birth weight infant with Morganella morganii bacteremia and peritonitis [J]. AJP Rep, 2021, 11(2): e113-e118.
[3] Paul SP, Newman LM, Mubashar Y, et al. Morganella morganii: a rare cause of early onset neonatal sepsis and meningitis [J]. Br J Hosp Med(Lond), 2020, 81(10): 1-3.
[4] Anagnostakos K, Grzega C, Sahan I, et al. Occurrence of rare pathogens at the site of periprosthetic hip and knee joint infections: a retrospective, single-center study [J]. Antibiotics(Basel), 2021, 10(7): 882. doi:10.3390/antibiotics10070882.
[5] Almater AI, Abusayf MM, Alshahrani S, et al. Paraneoplastic pemphigus associated with rapidly progressing endophthalmitis caused by Morganella morganii: a case report [J]. Eur J Ophthalmol, 2021, 11206721211033465. doi: 10.1177/11206721211033465.
[6] 李春辉, 吴安华. MDR、XDR、PDR多重耐药菌暂行标准定义—国际专家建议[J].中国感染控制杂志, 2014,13(1): 62-64. LI Chunhui, WU Anhua. Interim standard definitions of MDR, XDR and PDR multidrug resistant bacteria: international expert recommendations [J]. Chinese Journal of Infection Control, 2014,13(1): 62-64.
[7] Yang JH, Sheng WH, Hsueh PR. Antimicrobial susceptibility and distribution of extended-spectrum β-lactamases, AmpC β-lactamases and carbapenemases among Proteus, Providencia and Morganella isolated from global hospitalised patients with intra-abdominal and urinary tract infections: results of the Study for Monitoring Antimicrobial Resistance Trends(SMART), 2008-2011 [J]. J Glob Antimicrob Resist, 2020, 22: 398-407. doi: 10.1016/j.jgar.2020.04.011.
[8] 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. HU Fupin, GUO Yan, ZHU Demei, et al. Antimicrobial resistance profile of clinical isolates in hospitals across China: report from the CHINET Surveillance Program, 2017 [J]. Chinese Journal of Infection and Chemotherapy, 2018, 18(3): 241-251.
[9] 胡付品, 郭燕, 朱德妹, 等. 2018年CHINET中国细菌耐药性监测[J]. 中国感染与化疗杂志, 2020, 20(1): 1-10. HU Fupin, GUO Yan, ZHU Demei, et al. CHINET surveillance of bacterial resistance in China: 2018 report [J]. Chinese Journal of Infection and Chemotherapy, 2020, 20(1): 1-10.
[10] 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. HU Fupin, GUO Yan, ZHU Demei, et al. CHINET surveillance of bacterial resistance across tertiary hospitals in 2019 [J]. Chinese Journal of Infection and Chemotherapy, 2020, 20(3): 233-243.
[11] 胡付品, 郭燕, 朱德妹, 等. 2020年CHINET中国细菌耐药监测[J]. 中国感染与化疗杂志, 2021, 21(4): 377-387. HU Fupin, GUO Yan, ZHU Demei, et al. CHINET surveillance of bacterial resistance: results of 2020 [J]. Chinese Journal of Infection and Chemotherapy, 2021, 21(4): 377-387.
[12] Shi H, Chen X, Yao Y, et al. Morganella morganii: an unusual analysis of 11 cases of pediatric urinary tract infections [J]. J Clin Lab Anal, 2022, 36(5): e24399. doi:10.1002/jcla.24399.
[13] Laupland KB, Paterson DL, Edwards F, et al. Morganella morganii, an emerging cause of bloodstream infections [J]. Microbiol Spectr, 2022, 10(3): e0056922. doi:1 0.1128/spectrum.00569-22.
[14] Amini M, Motie MR, Amel Jamehdar S, et al. Concomitant empyema and peritonitis with Morganella morganii in an immunocompetent patient: a case report [J]. Caspian J Intern Med, 2021, 12(2):232-235.
[15] Zaric RZ, Jankovic S, Zaric M, et al. Antimicrobial treatment of Morganella morganii invasive infections: systematic review [J]. Indian J Med Microbiol, 2021, 39(4): 404-412.
[16] Bandy A. Ringing bells: Morganella morganii fights for recognition [J]. Public Health, 2020, 182: 45-50. doi: 10.1016/j.puhe.2020.01.016.
[17] Learman BS, Brauer AL, Eaton KA, et al. A rare opportunist, Morganella morganii, decreases severity of polymicrobial catheter-associated urinary tract infection [J]. Infect Immun, 2019, 88(1): e00691-19.
[18] 胡丽庆,黄宇雯. 摩根摩根菌的临床分布及耐药性分析[J]. 中国卫生检验杂志, 2017, 27(8): 1182-1184. HU Liqing, HUANG Yuwen. Study on the clinical distribution and drug-resistance of Morganella morganii [J]. China Journal of Health Inspection, 2017, 27(8): 1182-1184.
[19] 夏冰, 郭远瑜. 摩根摩根菌的临床分布及碳青霉烯类药物敏感性分析[J]. 中国卫生检验杂志, 2019, 29(14): 1703-1705. XIA Bing, GUO Yuanyu. Clinical distribution of Morganella morganii and drug sensitivity analysis of carbapenems [J]. China Journal of Health Inspection, 2019, 29(14): 1703-1705.
[20] 王磊, 杨雪静, 陈益民. 摩根摩根菌临床分布及耐药性分析[J]. 中国微生态学杂志, 2016, 28(10):1194-1196. WANG Lei, YANG Xuejing, CHEN Yimin. Clinical distribution and antimicrobial resistance of Morganella morganii [J]. Chinese Journal of Microecology, 2016, 28(10): 1194-1196.
[21] 李金, 胡志东, 汪复, 等. 2005—2014年CHINET变形杆菌属, 沙雷菌属, 枸橼酸杆菌属,摩根菌属及普罗威登菌属细菌耐药性监测[J]. 中国感染与化疗杂志, 2016, 16(3): 284-293. LI Jin, HU Zhidong, WANG Fu, et al. Changing resistance profile of Proteus, Serratia, Citrobacter, Morganella and Providencia isolates in hospitalsacross China: data from CHINET Antimicrobial Resistance Surveillance Program 2005-2014 [J]. Chinese Journal of Infection and Chemotherapy, 2016, 16(3): 284-293.
[22] 王凤霞, 安新业, 李金玲, 等. 2011—2018年滨州市某院大肠埃希菌的分布及耐药性[J].国际流行病学传染病学杂志, 2020, 47(2): 149-153. WANG Fengxia, AN Xinye, LI Jinling, et al. Distribution and drug resistance of Escherichia coli isolated in one hospital of Binzhou during 2011-2018 [J]. International Journal of Epidemiology and Infectious Diseases, 2020, 47(2), 149-153.
[23] 邓慧玲, 张玉凤, 蔡慧君, 等. 儿童嗜麦芽窄食单胞菌临床分离株耐药性多中心研究[J].中国感染与化疗杂志, 2021, 21(4): 456-460. DENG Huiling, ZHANG Yufeng, CAI Huijun, et al. A multicenter study on drug resistance of clinical isolates of Stenotrophomonas maltophilia in children [J]. Chinese Journal of Infection and Chemotherapy, 2021, 21(4): 456-460.
[24] Stultz JS, Bice T, Johnstone K, et al. Importance of reviewing antibiotic courses by 48 hours: risk factors for third-generation cephalosporin resistance among Amp-Charboring organisms in urine and respiratory cultures [J]. Pediatr Infect Dis J, 2021, 40(5): 440-445.
[25] 赵晓东, 吕传柱, 于学忠, 等. 喹诺酮类抗菌药物急诊临床应用指导意见[J]. 中国急救医学, 2020, 40(11): 1047-1056. ZHAO Xiaodong, LV Chuanzhu, YU Xuezhong, et al. Guidelines for the emergency clinical application of quinolones [J]. Chinese Emergency Medicine, 2020, 40(11): 1047-1056.
[1] 曹爱华,段春红,邱丙平,路苓,李可亮, 刘学工,周志远,孙建华,鞠秀丽. 山东省儿童新型冠状病毒感染者流行病学及临床特征[J]. 山东大学学报 (医学版), 2020, 58(6): 34-40.
[2] 周生余,王春亭,张伟,王锡明,董亮. 山东省新型冠状病毒肺炎患者537例临床特征与救治效果[J]. 山东大学学报 (医学版), 2020, 58(3): 44-51.
[3] 刘冠邑,杨丽媛,付振涛,徐爱强,郭晓雷. 2014年山东省口腔癌发病和死亡水平分析[J]. 山东大学学报 (医学版), 2019, 57(7): 102-107.
[4] 何东炀,孙基耀,王萌,王健,黄果. 山东省某三甲医院2006年与2016年住院患者疾病特征对比分析[J]. 山东大学学报 (医学版), 2018, 56(4): 81-86.
[5] 赵庆庆,尹格平. TNF-α 启动子5个位点的基因多态性与山东省汉族妇女宫颈癌遗传易感性的相关性[J]. 山东大学学报 (医学版), 2018, 56(2): 28-33.
[6] 王美建,侯新国,梁凯,陈丽. 山东省城市中老年人群血脂现状调查[J]. 山东大学学报(医学版), 2017, 55(5): 70-75.
[7] 杨丁,杨鹏,李玉波,孙强. 基于面板数据的村卫生室上呼吸道感染处方用药变化规律——以山东省Z县8个村卫生室为例[J]. 山东大学学报 (医学版), 2017, 55(12): 88-94.
[8] 陈吴康,吕翠霞,张晓菲,董蕾,杜以慧,傅继华. 女性性工作者吸食冰毒情况及其影响因素分析[J]. 山东大学学报(医学版), 2016, 54(9): 73-76.
[9] 李燕,刘坤,孙晓杰. 山东省3县农村老年人与收入相关的健康不平等状况及影响因素[J]. 山东大学学报(医学版), 2016, 54(6): 91-96.
[10] 王省,张喜雨,林炜炜,廉颖,张晴晴,李启龙,李士雪. 山东省远程医疗现状及存在问题分析[J]. 山东大学学报(医学版), 2016, 54(2): 90-94.
[11] 陈思, 王牧川, 任楠楠, 许巍, 王玲玲, 栾海辉, 马俊, 刘艺鸣. Parkin基因多态性与山东省汉族帕金森病发病风险的关系[J]. 山东大学学报(医学版), 2015, 53(4): 71-74.
[12] 王浩, 张娜, 薛付忠, 王萍, 康殿民, 刘言训. 山东省艾滋病病毒感染者及艾滋病患者空间流行特征[J]. 山东大学学报(医学版), 2015, 53(2): 81-86.
[13] 张敏, 穆晓楠, 马伟元, 党宁宁, 张楠. 山东省皮肤恶性黑色素瘤患者的临床特征与预后危险因素分析(附61例报告)[J]. 山东大学学报(医学版), 2015, 53(11): 80-84.
[14] 刘贞艳, 胡彬, 毕振旺, 寇增强, 房明, 陈保立, 任艳艳, 毕振强. 2013年山东省四地市儿童A群链球菌耐药特征及其表型、基因型分析[J]. 山东大学学报(医学版), 2015, 53(1): 77-80.
[15] 孟菲, 王耀华, 黄研, 吕浩. 某医院中药注射剂不合理用药情况的分析[J]. 山东大学学报(医学版), 2014, 52(Z1): 223-224.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!