2013年医院临床分离菌耐药性分析  

Surveillance of antimicrobial resistance of clinical bacterial isolates in a hospital during 2013

作　　者：尧荣凤[1] 许国祥[2] 薛龙[1] 沈菊英[1] 李智[1] 夏嵘[1] 肖启纹 

机构地区：[1]上海市杨浦区中心医院检验科,上海200090 [2] 上海市第七人民医院

出　　处：《中国感染与化疗杂志》2015年第3期244-248,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解医院临床常见细菌的耐药现状,为医院合理用药提供参考。方法采用VITEK-2全自动微生物分析仪对临床分离株进行鉴定和药敏试验,结果按照CLSI 2013年版标准判定,耐药性数据分析采用WHONET5.6软件。结果 2013年医院患者首次分离细菌3 880株,其中革兰阳性菌占35.2%(1 366株),革兰阴性菌占64.8%(2 514株),居前6位的细菌依次为:大肠埃希菌(20.2%)、肺炎克雷伯菌(12.0%)、铜绿假单胞菌(11.1%)、凝固酶阴性葡萄球菌(9.8%)、鲍曼不动杆菌(9.8%)和粪肠球菌(8.1%)。细菌主要分离自呼吸道(51.0%)、尿液(26.2%)、血液(9.4%)。耐甲氧西林的葡萄球菌属>72.0%,未发现耐万古霉素、替加环素和利奈唑胺的葡萄球菌。509株肠球菌属细菌中,粪肠球菌和屎肠球菌分别占61.5%和32.8%,未发现耐万古霉素和替加环素的肠球菌。肠球菌对替考拉宁和利奈唑胺耐药率均<2.0%。大肠埃希菌和克雷伯菌属产超广谱β内酰胺酶(ESBL)检出率分别为67.4%和32.0%。药敏结果显示,酶抑制剂复方制剂(头孢哌酮-舒巴坦和哌拉西林-他唑巴坦)、碳青霉烯类(美罗培南、亚胺培南和厄他培南)和阿米卡星对大肠埃希菌、克雷伯菌属、肠杆菌属(阴沟肠杆菌和产气肠杆菌)和奇异变形杆菌具有较好的抗菌活性,耐药率均<15.0%。其中,肺炎克雷伯菌对大多数抗菌药物的耐药性高于其他的革兰阴性杆菌。在不发酵糖革兰阴性菌中,以铜绿假单胞菌和不动杆菌属为主。铜绿假单胞菌对阿米卡星、妥布霉素、头孢吡肟、庆大霉素和哌拉西林-他唑巴坦耐药率均<15.0%,但对碳青霉烯类(美罗培南和亚胺培南)的耐药率均>20.0%。鲍曼不动杆菌的耐药性严重,对所有受试抗菌药物的耐药率均>35.0%。结论细菌耐药性仍对临床抗感染治疗构成严重威胁,应合理使用抗菌药物以降低耐药性。同时,对耐药菌集中的科室及早进行流行病学调查并采取积极�Objective To investigate the antibiotic resistance of clinical isolates from hospital for the guidance of rational use of antibiotics .Methods Automatic VITEK‐2 system was used to identify bacterial strains and analyze the antimicrobial resistance . WHONET 5 .6 was applied for data analysis according to the breakpoints of Clinical and Laboratory Standards Institute 2013 . Results A total of 3 880 nonduplicate strains were collected in 2013 ,35 .2% （1 366/3 880） of which were gram positive organisms ,64 .8% （2 514/3 880） were gram negative bacteria .The top 6 most frequently isolated microorganisms were E . coli （20 .2% ） , K . pneumoniae （12 .0% ） , P . aeruginosa （11 .1% ） , coagulase negative Staphylococcus （9 .8% ） , A . baumannii （9 .8% ） ,E .f aecalis （8 .1% ） .The bacteria were mainly isolated from respiratory tract （51 .0% ） ,urine （26 .2% ） , and blood （9 .4% ） .The prevalence of both meticillin‐resistant Staphylococcus was higher than 72 .0% .No staphylococcal strainwasfoundresistanttolinezolid,vancomycinortigecycline.Amongthe509Enterococcusisolates,E.faecalisandE. f aecium accounted for 61 .5% and 32 .8% ,respectively .No enterococcal strain was resistant to vancomycin or tigecycline . Enterococcal isolates also showed low resistance （〈2 .0% ） to teicoplanin and linezolid .About 67 .4% of the E .coli strains and 32 .0% of the K lebsiella isolates produced extended spectrumbeta‐lactamases.Thestrainsof E.coli,Klebsiella spp.,Enterobacterspp.,and Proteusspp.wererelatively susceptible to beta‐lactam/beta‐lactamase inhibitor combinations such as cefoperazone‐sulbactam and piperacillin‐tazobactam , carbapenems such as meropenem ,imipenem and ertapenem ,and amikacin （〈 15 .0% of the strains were resistant） . K . pneumoniae isolates were more resistant than other gram‐negative bacilli .P .aeruginosa was relatively susceptible to amikacin , tobramycin ,cefepime ,gentamicin ,piperacillin‐tazobactam ,but more than 20% of these strains were r

关 键 词：细菌耐药性 抗菌药物 药敏试验 

分 类 号：R446.5[医药卫生—诊断学]