2011-2013年某综合性医院产ESBLs细菌的分布及耐药动态监测  

Distribution analysis and drug resistance monitoring on the ESBLs-producing strains in a general hospital from 2011 to 2013

作　　者：朱瑞琪[1] 张蕴莉[1] 张淑芹[1] 李昆[1] 王艳[1] 

机构地区：[1]辽宁医学院附属第一医院检验科,辽宁锦州121000

出　　处：《现代预防医学》2015年第18期3450-3453,共4页Modern Preventive Medicine

摘　　要：目的通过每年监测某院住院患者产超广谱β-内酰胺酶(ESBLs)细菌在革兰阴性杆菌中的分布状况及耐药特征,以便及时有效地指导临床合理使用抗菌药物。方法对锦州市辽宁医学院附属第一医院2011年1月-2013年12月分离的病原菌进行目标性监测,统计产ESBLs的株数及在重点科室的分布,并对每年产ESBLs细菌的耐药性进行动态监测;采用WHO细菌耐药性监测网提供的WHONET5.4进行数据统计分析。结果 3年来产ESBLs检出率从22.97%上升至24.97%;标本主要分布于痰液、尿液、血液中;以ICU、神经外科、综合泌尿外科为主要科室来源;除头孢他啶和头孢西丁外,产ESBLs菌株对其他头孢菌素耐药率均>90%,且呈逐年增加态势;喹诺酮类药物虽有下降但活性较差,耐药率均大于70%;酶联合抑制剂耐药率虽有增加,但抗菌作用仍较强;亚胺培南耐药率增长幅度较小,由13.00%上升至13.90%。结论该院产ESBLs株对各类抗生素的耐药率总体呈上升趋势,并呈现出多重耐药。亚胺培南仍为首选治疗药。应加强临床合理应用抗菌药物的管理,同时应加强产ESBLs细菌的监测,预防和减少耐药菌株的产生。Objective The aim of this study was to investigate the distribution of the major hospital strains of ESBLs （Extended Spectrum Bata-lactamase） production in Gram-negative bateria and to monitor their susceptibility to antimicrobial drugs in the recent three years, in order to guide the clinical rational use of antimicrobial agents effectively and reasonably. Methods Bacteria from hospitalized patients of the first affiliated hospital of Liaoning medical college in Jinzhou from January 2011 to December 2013 were cultured for the monitoring of target pathogens. The WHONETS.4 software recommended by WHO bacterial drug resistance monitoring network was used for statistical analysis. Numbers and the key departments of ESBLs-producing strains as well as the annual drug resistance rate were monitored. Results The ratio of ESBLs detection rate rose from 20% to 25%. The strains were mainly isolated from sputum, followed by urine and blood. The main sections for the collection of samples were ICU, neurosurgery, and urology. Except for ceftazidime and cefoxitin, other cephalosporin resistance rate of ESBLs-producing strains increased every year and was above 90% for three years, while for quinolones, although the rate was decreased, the resistance rate was still more than 70%. The resistance rate towards enzyme inhibitor increased, but still had a strong antibacterial effect. Imipenem resistance rate had a subtle increase, which was from 13% to 14%. Conclusion The resistance rate of ESBLs production strains of various types of antibiotics overall went upward, and showed a multi-drug resistance. Imipenem was still the preferred treatment drug. To prevent and reduce the generation of resistant strains, we should strengthen the management of clinical rational use of antimicrobial drugs and strengthen the monitoring of ESBLs-producing stains.

关 键 词：超广谱Β-内酰胺酶 耐药监测 多重耐药 

分 类 号：R378[医药卫生—病原生物学]