2014年安徽医科大学第一附属医院细菌耐药性监测  

Surveillance of antibiotic resistance in clinical isolates from the First Affiliated Hospital of Anhui Medical University during 2014

作　　者：潘亚萍[1] 王中新[1] 徐元宏[1] 黄颖[1] 金先彬[1] 吴庆[1] 沈继录[1] 

机构地区：[1]安徽医科大学第一附属医院检验科,合肥230032

出　　处：《中国感染与化疗杂志》2016年第4期494-501,共8页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金(81171618)

摘　　要：目的了解安徽医科大学第一附属医院2014年临床分离菌的组成及对抗菌药物的耐药性。方法采用纸片扩散法或自动化仪器法进行抗菌药物敏感性试验，按临床和实验室标准化协会（CLSI）2014年标准判读药敏结果，使用WHONET5．6软件进行统计分析。结果共收集5533株临床分离株，其中革兰阳性菌1410株，占25．5％；革兰阴性菌4123株，占74．5％。分离菌中大肠埃希菌最多，占22．0％，其次是肺炎克雷伯菌，占12．3％。细菌主要来自于呼吸道和尿液标本，分别占37．0％、30．4％。耐甲氧西林金黄色葡萄球菌（金葡菌）（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为56．2％和84．2％。甲氧西林耐药株对β内酰胺类抗生素和其他大多数抗菌药物的耐药率显著高于甲氧西林敏感株。尚未发现万古霉素耐药的葡萄球菌。肠球菌属细菌中屎肠球菌占49．1％，粪肠球菌占50．9％，屎肠球菌对大多数抗菌药物的耐药率明显高于粪肠球菌。屎肠球菌已出现少数耐万古霉素的菌株，粪肠球菌仍对万古霉素全部敏感。大肠埃希菌、克雷伯菌属以及奇异变形杆菌中产ESBL菌株的检出率分别为65．2％、35．2％、12．1％。上述产ESBL株对大多数抗菌药物的耐药率显著高于非产ESBL株。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感，总耐药率4．1％～8．1％。假单胞菌属对碳青霉烯类抗生素的耐药率〉20％，对阿米卡星的敏感率最高，为90．2％。不动杆菌属对大多数抗菌药物的耐药率均〉50％，伯克霍尔德菌属（除对替卡西林．克拉维酸）和窄食单胞菌属对2014年CLSI推荐的药物均有较高的敏感率。结论细菌耐药性呈增长趋势，对临床抗感染治疗构成严重威胁，应重视耐药监测并加强抗生素的合理使用。Objective To investigate the antibiotic resistance of clinical isolates in the First Affiliated Hospital of Anhui Medical University during 2014. Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby- Bauer method or automated systems. Results were analyzed according to the breakpoints of CLSI 2014. The data were analyzed by WHONET 5.6 software. Results A total of 5 533 nonduplicate clinical isolates were collected. Gram-positive cocci and gram-negative bacilli accounted for 25.5 % （1 410/5 533） and 74.5 % （4 123/5 533）, respectively. The most frequently isolated microorganisms were E. coli （22.0 %）, followed by K. pneumoniae （12.3 %）. The strains were mainly isolated from respiratory tract （37.0%） and urine （30.4 %）. The prevalence of methicillin-resistant isolates was 56.2 % in Staphylococcus aureus and 84.2 % in coagulase negative Staphylococcus. The resistance rates of methicillin-resistant strains to beta-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible strains. No strains were found resistant to vancomycin. E. faecium and E. faecalis accounted for 49.1% and 50.9 % of all the Enterococcus isolates, respectively. E. faecium strains showed higherresistance rates to most antibiotics than E. faecalis. No E. faecalis strains were found resistant to vancomycin. A few E. faecium strains were resistant to vancomycin. The prevalence of ESBLs-producing strains was 65.2% in E.coli, 35.2 % in Klebsiella spp and 12.1% in P. mirabilis. The resistance rate of ESBLs-producing strains was significantly higher than non-ESBLs-producing strains. Enterobacteriaceae strains were still highly susceptible to carbapenems antibiotics, the resistance rate to which was 4.1% to 8.1%. More than 20 % of the Pseudomonas strains were resistant to carbapenems. These strains were highly susceptible to amikacin （90.2 % susceptible）. More than 50 % of the Acinetobacter strains were resistant to most of the antibiotics test

关 键 词：细菌耐药性监测 抗菌药物 耐甲氧西林葡萄球菌 超广谱Β内酰胺酶 

分 类 号：R446.5[医药卫生—诊断学] R197.32[医药卫生—临床医学]