2013年山东省立医院细菌耐药性监测  

Surveillance of antibiotic resistance in clinical isolates from Shandong Provincial Hospital during 2013

作　　者：邵春红[1] 金炎[1] 刘义刚[1] 张淼[1] 李平[1] 郭凤琴[1] 王勇[1] 

机构地区：[1]山东大学附属省立医院检验科,济南250021

出　　处：《中国感染与化疗杂志》2015年第2期126-133,共8页Chinese Journal of Infection and Chemotherapy

基　　金：山东省科技发展计划项目(2012GGB14100);山东省临床重点专科建设项目经费资助(鲁卫医字[2013]26号)

摘　　要：目的了解山东省立医院2013年临床分离细菌对抗菌药物的耐药性。方法除葡萄球菌属采用VITEK2 Compact测定其药物敏感性外,其余菌株均采用纸片扩散法。参照CLSI 2013版折点判读结果,使用WHONET5.6软件统计分析。结果 2013年共收集非重复临床分离菌4 482株,其中革兰阴性菌占74.19%,革兰阳性菌占25.81%。呼吸道标本所占比率最高(37.66%),其次为尿液(21.55%)和无菌体液标本(18.38%)。分离菌中排在前5位的依次为大肠埃希菌(24.56%)、铜绿假单胞菌(11.71%)、肺炎克雷伯菌(11.2%)、金黄色葡萄球菌(金葡菌)(10.51%)和鲍曼不动杆菌(5.89%)。大肠埃希菌和肺炎克雷伯菌产超广谱β内酰胺酶(ESBL)的比率分别为59.22%和34.06%。产ESBL菌株对大多数抗菌药物的耐药率均比非产ESBL菌株高。出现对亚胺培南、美罗培南和厄他培南耐药的肠杆菌科细菌。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为11.2%和10.1%。鲍曼不动杆菌除对米诺环素和头孢哌酮-舒巴坦耐药率为31.2%和23.4%外,对其他抗菌药物的耐药率均在40%以上。甲氧西林耐药金葡菌(MRSA)的检出率为27.6%。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌属。屎肠球菌对多数药物的耐药率均高于粪肠球菌,未发现万古霉素耐药的肠球菌属。肺炎链球菌主要来源于儿科病房(56.41%),均为非脑膜炎菌株,儿童分离株中青霉素耐药肺炎链球菌(PRSP)所占比例高于成人分离株。结论细菌耐药性呈增高趋势,应重视细菌耐药性监测并加强抗菌药物的合理使用。Objective To investigate the antibiotic resistance of clinical isolates in Shandong Provincial Hospital during 2013.Methods The antimicrobial susceptibility of staphylococcal strains were tested by using VITEK2 Compact.The other strains were tested by disk diffusion method.All the data were analyzed by WHONET 5.6 software according to CLSI 2013 breakpoints.Results A total of 4 482 non-duplicate clinical strains were collected during 2013,of which gram-negative rods and gram-positive cocci accounted for 74.19% and 25.81%,respectively.The most common specimen source was respiratory tract（37.66%）,followed by urine（21.55%）and sterile body fluid（18.38%）.Escherichia coli（24.56%）was the most frequently isolated bacteria,followed by Pseudomonas aeruginosa（11.71%）,Klebsiella pneumoniae（11.2%）,Staphylococcus aureus（10.51%）and Acinetobacter baumannii（5.89%）.The prevalence of ESBLs was 59.22%in the strains of E.coli and34.06%in K.pneumoniae strains.The resistance rate of ESBLs-positive strains was higher than ESBLs-negative strains to most antibiotics.Some strains of Enterobacteriaceae were resistant to imipenem,meropenem or ertapenem.The percentage of the P.aeruginosa strains resistant to imipenem and meropenem was11.2% and 10.1%,respectively.More than 40% of the A.baumannii strains were resistant to all the antibiotics tested except minocycline（31.2%）and cefoperazone（23.4%）.The prevalence of methicillin-resistant S.aureus（MRSA）was27.60%.No strains were found resistant to vancomycin,teicoplanin or linezolid in Staphylococcus or Enterococcus isolates.The percentage of the E.faeciumstrains resistant to most antibiotics tested was higher than that of E.faecalis.All the S.pneumoniae strains were non-meningitis strains,mainly isolated from children′s ward（56.41%）.The higher prevalence of penicillin-resistant S.pneumoniae was found in the strains isolated from children compared to the isolates from adults.Conclusions Bacterial resistance is on the rise.More attention should be pai

关 键 词：细菌耐药性监测 抗菌药物 药敏试验 泛耐药菌 

分 类 号：R446.5[医药卫生—诊断学]