2016年山东省立医院细菌耐药性监测  

Surveillance of antibiotic resistance of clinical isolates in Shandong Provincial Hospital during 2016

作　　者：张裕珍 张琳 金炎[3] 王月玲[3] 邵春红[3] 

机构地区：[1]山东省枣庄市峄城区中医院检验科,山东枣庄277300 [2]江苏省常州市金坛中医院内分泌科 [3]山东大学附属省立医院检验科

出　　处：《中国感染与化疗杂志》2017年第5期576-583,共8页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金项目(81401696);山东省科技发展计划项目(2016GSF201078)

摘　　要：目的了解山东省立医院2016年临床分离细菌对抗菌药物的耐药性。方法采用纸片扩散法或VITEK 2-Compact仪器法测定分离株的药物敏感性,参照CLSI 2016版折点判读结果,使用WHONET5.6软件统计分析。结果 2016年共收集非重复临床分离菌4 810株,其中革兰阴性菌3 376株(70.2%),革兰阳性菌1 434株(29.8%)。病原菌来源呼吸道标本所占比率最高(38.1%),其次为皮肤软组织标本(21.2%)和尿液(17.5%)。分离菌中排在前5位的依次为大肠埃希菌(24.3%)、金黄色葡萄球菌(10.2%)、铜绿假单胞菌(9.9%)、克雷伯菌属(9.8%)和肠球菌属(9.6%)。大肠埃希菌和肺炎克雷伯菌ESBL的阳性率分别为55.0%和37.9%。碳青霉烯类耐药的大肠埃希菌和肺炎克雷伯菌分别占1.6%和4.2%。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为24.3%和21.9%。鲍曼不动杆菌除对米诺环素耐药率为33.2%外,对其他抗菌药物的耐药率均在40%以上。流感嗜血杆菌和卡他莫拉菌β内酰胺酶阳性率分别为70.1%和97.5%。MRSA的检出率为31.4%。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌属。屎肠球菌对多数药物的耐药率均高于粪肠球菌,发现1株万古霉素和替考拉宁耐药的屎肠球菌。共分离肺炎链球菌191株,143株(74.9%)来自儿科病房,其中非脑脊液分离株未发现青霉素耐药菌株,其他溶血链球菌对青霉素、头孢菌素及万古霉素均较敏感。结论细菌耐药率呈增高趋势,应重视细菌耐药性监测并加强抗菌药物的合理使用。Objective To investigate the antibiotic resistance of clinical isolates in Shandong Provincial Hospital during 2016. Method The antimicrobial susceptibility of isolates was tested by using VITEK 2-Compact system or disk diffusion method. All the data were analyzed by WHONET 5.6 software according to CLSI 2016 breakpoints. Results A total of 4 810 non-duplicate clinical strains were collected during 2016, of which gram-negative bacilli and gram-positive cocci accounted for 70.2% and 29.8%, respectively. The most common specimen source was respiratory tract （38.1%）, followed by skin and soft tissue （21.1%） and urine （17.5%）. Escherichia coli was the most frequently isolated bacteria, followed by Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella and Enterococcus, accounting for 24.3%, 10.2%, 9.9%, 9.8% and 9.6%, respectively. The prevalence of ESBLs-positive E. coli and K. pneumoniae was 55.0% and 37.9%, respectively. Carbapenem-resistant E. coli and K. pneumoniae accounted for 1.6% and 4.2%, respectively. The percentage of P. aeruginosa resistant to imipenem and meropenem was 24.3% and 21.9%, respectively. More than 40% of the A. baumannii strains were resistant to all the antibiotics tested except minocycline （33.2%）. The prevalence of beta-lactamase positive strains was 70.1% in H. influenzae and 97.5% in M. catarrhalis. The prevalence of methicillin-resistant S. aureus （MRSA） was 31.4%. No staphylococcal strains were found resistant to vancomycin,teicoplanin or linezolid. E. Jhecium strains showed higher resistance rate to most antibiotics tested than E. Jhecalis. One strain of E. ./aecium was resistant to both vancomycin and teicoplanin. A total of 191 strains ofS. pnezzmoniae were isolated, of which 143 （74.9%） isolates were from pediatric wards. None of the non-meningitis strains was resistant to penicillin. Other hemolytic Streptococcus strains were sensitive to penicillin, cephalosporins and vancomycin. Conclusions Bacterial resistance is still on rise. We should pay more att

关 键 词：细菌耐药性监测 抗菌药物 药敏试验 

分 类 号：R446.5[医药卫生—诊断学]