2013～2015年上海某三级甲等医院细菌耐药性监测  

Analysis of bacterial resistance in a third-grade class-A hospital from 2013 to 2015

作　　者：瞿跃红[1] 李漫[1] 郭海燕[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院检验科,上海201900

出　　处：《中国医药导报》2017年第8期20-23,共4页China Medical Herald

基　　金：上海市教育委员会科研创新项目(14YZ047)

摘　　要：目的分析上海交通大学医学院附属第九人民医院北院2013~2015年病原菌分布、来源、耐药性和耐药菌谱变化,为临床合理使用抗菌药提供实验室依据。方法收集2013~2015年临床分离的14 192株非重复细菌,应用纸片扩散法(或MIC法)进行药敏试验,依据CLSIM100-25版标准对药敏试验结果进行判断,应用WHONET5.6软件进行耐药性分析。结果从14 192株非重复细菌分类看,革兰阴性菌8472株(59.70%),革兰阳性菌2391株(16.85%),真菌3329株(23.46%)。革兰阴性菌以大肠埃希菌(26.75%)、鲍曼不动杆菌(12.24%)、铜绿假单胞菌(8.98%)为主,革兰阳性菌以肠球菌属(6.07%)和葡萄球菌(5.57%)为主,真菌主要是白色念珠菌(14.29%)。耐药菌株来源前3位为痰及咽拭子、尿、血液。3年间鲍曼不动杆菌对氨苄西林/舒巴坦、头孢哌酮/舒巴坦耐药率逐年升高,对米诺环素、复方新诺明、阿米卡星耐药率有小幅降低;铜绿假单胞菌对美洛培南的耐药率有小幅升高,对阿米卡星的耐药率有小幅降低。结论革兰阴性菌是医院抗菌药产生耐药性的主要细菌,医院可根据病原菌分布及其耐药特点选择合适的抗菌药物,以提高药物使用的合理性。Objective To analyze the distribution, source, drug resistance and drug-resistant bacteria spectrum changes of the pathogens in North Hospital of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from 2013 to 2015, in order to provide the laboratory basis for the rational use of antimicrobial agents.Methods A total of 14 192 strains of non-repetitive bacterial isolated from clinic from 2013 to 2015 were collected.Drug susceptibility test was performed by disc diffusion method（or MIC method）. The sensitivity test results were evaluated according to the standard of CLSIM100-25 and analyzed by WHONET 5.6 software. Results From the 14 192non-repetitive bacterial species, there were 8472 strains（59.70%） of gram-negative bacilli, 2391 strains（16.85%） of grampositive bacilli and 3329 strains（23.46%） of fungi. Gram-negative bacilli were predominantly Escherichia coli（26.75%）, Acinetobacter baumannii（12.24%） and Pseudomonas aeruginosa（8.98%）. Gram-positive bacilli were mainly Enterococcus（6.07%） and Staphylococcus（5.57%）. The main fungi was Candida albicans（14.29%）. The top three sources of drug resistant strains were from sputum and pharyngeal swab, urine and blood. In the three years, the resistance rates of Acinetobacter baumannii to Ampicillin/Sulbactam, Cefoperazone/Sulbactam gradually increased, and the resistance rates to Minocycline, Sulfamethoxazole Compound, Amikacin reduced. The resistance rate of Pseudomonasaeruginosa to Meropenem had a little increased, and the resistance rate to Amikacin reduced. Conclusion Gram-negative bacilli is the main antibiotic resistance bacteria in hospital. Based on the distribution of pathogens and drug resistance characteristics, hospital should choose appropriate antibiotics to improve the rational use of drugs.

关 键 词：病原菌分布 耐药性 抗菌药 

分 类 号：R195.1[医药卫生—卫生统计学]