2011—2013年医院临床分离菌耐药性分析  

Antimicrobial Resistance in Clinical Bacterial Isolates in Hospital,2011-2013

作　　者：钟海波[1] 汪得喜[1] 李勤[2] 彭湘明[3] 林健濂[1] 潘海燕[1] 

机构地区：[1]广州市红十字会医院呼吸科,广州510220 [2]广州市红十字会医院感染科,广州510220 [3]广州市红十字会医院检验科,广州510220

出　　处：《实用临床医学（江西）》2015年第4期4-8,共5页Practical Clinical Medicine

基　　金：广东省科技厅科研项目(2008B030301012)

摘　　要：目的分析2011—2013年医院临床分离致病菌的耐药特点。方法对2011—2013年广州市红十字会医院临床科室送检标本,采用全自动细菌分析仪和纸片扩散法进行细菌鉴定和抗菌药物敏感性试验(药敏试验),以美国临床实验室标准委员会(CLSI)标准判定抗菌药物敏感性。结果共分离7 326菌株。其中革兰阳性菌占33.1%,革兰阴性菌占66.9%。2011—2013年排名前列细菌均为大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌、肺炎克雷伯菌、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、粪肠球菌、屎肠球菌,占总分离菌株的76.0%。肠杆菌科细菌对亚胺培南和美罗培南的耐药率为0.0%,但在2012年出现对亚胺培南和美罗培南耐药的肺炎克雷伯菌。鲍曼不动杆菌除对多黏菌素外,对其他常用抗菌药物的耐药率均>60.0%,尤其对碳青霉烯类抗生素耐药水平均>80.0%,且有逐年上升趋势。铜绿假单胞菌耐药率有下降趋势,对阿米卡星、美罗培南耐药率维持在30.0%以下。葡萄球菌属中耐甲氧西林金黄色葡萄球茵(MRSA)和MRSCNS检出率分别为56.1%和77.8%,未发现对万古霉素、替考拉宁和利奈哇胺的耐药茵株。检出的MRSA对大环内酯类、氨基糖苷类、喹诺酮类耐药率>75.0%。屎肠球菌株对万古霉素和替考拉宁的耐药率为4.9%。结论医院主要临床分离菌耐药现象不一且不断变化,碳青霉烯类抗生素对除鲍曼不动杆菌外的主要革兰阴性菌尚有较好的敏感性,糖肽类抗菌药物则对革兰阳性菌有较好的活性。临床工作中应根据药敏结果选用药物,避免引发耐药。ABSTRACT:Objective To investigate the antimicrobial resistance in clinical isolates of pathogens in 2011-2013 in Guangzhou Red Cross Hospital.Methods Antimicrobial susceptibility testing was carried out using Kirby-Bauer disc diffusion method and bacterial identification was performed using automatic bacterial analyzer for detecting the clinical samples from various departments of Guangzhou Red Cross Hospital.Antimicrobial susceptibility was interpreted according to the CLSI breakpoints.Results A total of 7 326 clinical isolates were collected,including gram negative bacteria(66.9%)and gram positive bac-teria(33.1%).In 2011-2013,Escherichia coli,Acinetobacter baumannii,Pseudomonas aeruginosa,methi-cillin-resistant Staphylococcus aureus (MRSA ),Klebsiella pneumoniae,methicillin-resistant coagulase negative Staphylococcus(MRCNS),Enterococcus faecalis and Enterococcus faecium accounted for 7 6 .0%of the total isolates.The resistance rates of Enterobacteriaceae strains to meropenem and imipenem were 0.0%.However,imipenem and meropenem-resistant Klebsiella pneumoniae were found in 2012.More&nbsp;than 60.0% of the Acinetobacter baumannii strains were resistant to all the antibiotics tested except pol-ymyxin,especially to carbapenem antibiotics(>80.0%).The resistance of Acinetobacter baumannii to antibiotics increased year by year,but the resistance of Pseudomonas aeruginosa to antibiotics decreased year by year(resistance rates to amikacin and meropenem<30.0%).The detection rates of MRSA and MRCNS were 5 6 .1% and 7 7 .8%,respectively.No bacterial strains resistant to vancomycin,teicoplanin and linezolid were found.The resistance rates of MRSA to macrolides,aminoglycosides and quinolone were higher than 7 5 .0%.The resistance rates of Enterococcus feces to vancomycin and teicoplanin were 4.9%.Conclusion Multiple-drug-resistance phenomenon in the main clinical isolates varies and changes constantly.Except Acinetobacter baumannii,gram negative bacteria are sensitive to carbapenem antibiot-ics.Glycopeptide antibiotics are

关 键 词：抗菌药物 耐药性 耐碳青霉烯类鲍曼不动杆菌 耐万古霉素肠球菌 

分 类 号：R446.5[医药卫生—诊断学]