急诊科临床分离细菌耐药性分析  

Analysis of bacterial resistance in clinical isolates of emergency department

作　　者：李秀清[1] 秦冉冉 高磊[3] 孙立颖[2] 熊辉[1] 汪波[1] LI Xiu - qing 1a, QIN Ran - ran 1b, GAO Lei 1c, SUN Li - ying 1b, XIONG Hui 1a, WANG Bo1a(1.a Emergency Intensive Care Unit; b. Clinical Laboratory; c.Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100034, Chin)

机构地区：[1]北京大学第一医院急诊科,北京100034 [2]北京大学第一医院检验科,北京100034 [3]北京大学第一医院临床药理研究所,北京100034

出　　处：《中国临床药理学杂志》2018年第6期674-677,共4页The Chinese Journal of Clinical Pharmacology

摘　　要：目的了解北京大学第一医院急诊科2012年至2015年临床分离细菌的分布及抗菌药物耐药情况。方法收集急诊科2012年至2015年临床分离的非重复细菌,用纸片扩散法或自动化仪器法进行抗菌药物敏感性试验,按照美国临床和实验室标准协会(CLSI)2015标准判定药物敏感结果,用WHONET5.6软件进行统计分析。结果临床共分离1283株细菌,其中革兰氏阳性菌占30.6%,革兰氏阴性菌占69.4%。分离最多的前5位细菌分别是大肠埃希菌(18.4%),鲍曼不动杆菌(15.2%),金黄色葡萄球菌(13.3%),铜绿假单胞菌(12.7%)和肺炎克雷伯菌(8.8%)。耐甲氧西林金黄色葡萄球菌(MRSA)的平均检出率为75.6%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的平均检出率为83.1%,葡萄球菌中未发现对利奈唑胺、万古霉素耐药菌株。粪肠球菌对所测试的大多数抗菌药物的耐药率均明显低于屎肠球菌。超广谱β内酰胺酶(ESBLs)阳性大肠埃希菌的检出率为64.8%,克雷伯菌属细菌为40.5%。铜绿假单胞菌对亚胺培南、美罗培南耐药率分别为30.1%,28.4%,鲍曼不动杆菌对亚胺培南、美罗培南耐药率分别为83.5和83.0%。结论临床分离细菌对抗菌药物耐药性较高,MRSA、耐万古霉素肠球菌、泛耐药肠杆菌科细菌、泛耐药鲍曼不动杆菌、泛耐药铜绿假单胞菌的检出率较高,给临床治疗带来一定挑战。Objective To investigate the distribution and antibiotic resistance of clinical isolates from patients in emergency department of Peking University First Hospital from 2012 to 2015. Methods Antimicrobial susceptibility testing was performed with Kirby - Bauer or automated instrument method. The results were analyzed by WHONET 5.6 software according to CLSI 2015 breakpoints. Results Of the 1283 clinical isolates, gram -positive bacteria and gram -negative bacteria accounted for 30. 6% and 69.4% respectively. The 5 most common bacteria were Escherichia coli （ 18.4% ） ,Acinetobacter baumannii （ 15.2% ）, Staphy- lococcus aureus（ 13.3% ）, Pseudomonas aeruginosa （ 12.7% ） , Klebsiella pneumoniae （ 8.8% ） . Methicillin - resistant Staphyloccus aureus （MRSA） and methicillin -resistant coagulase -negative Staphylococcus （MRCNS） accounted for 75.6% and 83.1% . No Staphylococcal strain resistant to vancomycin, linezolid was detected. The resistance rate of E.faecalis strains to most of the antimicrobial agents tested was much lower than that of E.faecium. Extended - spectrum β - lactamase （ESBL） -producing strains accounted for 64. 8% and 40. 5% in E. coli and Klebsiellaspp respectively. The resistance rates of P. aeruginosa to imipenem and meropenem were 30. 1% and 28.4%. About 83.5% and 83.0% of A. baumannii were resistant to imipenem and meropenem. Conclusion The clinical isolated bacteria had high resistance to antibiotics. The detection rates of MRSA, vancomycin - resistant Enterococcus, extensively drug - resistant Enterobacteriaceae, extensively drug - resistant A. baumannii and extensively drugresistant P. aeruginosa were high, which brought some challenges to clinical treatment.

关 键 词：细菌耐药性监测 抗菌药物 泛耐药菌株 

分 类 号：R978.1[医药卫生—药品]