安徽医科大学第一附属医院2016年临床分离菌耐药性监测  

Surveillance report of antimicrobial resistance in the clinical isolates from the First Affiliated Hospital of Anhui Medical University during 2016

作　　者：曹林 沈继录[1] 王中新[1] 徐元宏[1] CAO Lin, SHEN Jilu, WANG Zhongxin, XU Yuanhong.(Department of Laboratory Medicine, the First Affed Hospital of Anhui Medical University, Hefei 230022, Chin)

机构地区：[1]安徽医科大学第一附属医院检验科,合肥230022

出　　处：《中国感染与化疗杂志》2018年第3期297-305,共9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2016年临床分离菌的构成和耐药情况,为临床合理化用药提供参考和依据。方法采用纸片扩散法和自动化仪器进行细菌耐药试验,按照临床和实验室标准化协会(CLSI)2015年标准判读药敏结果,并用WHONET 5.6软件进行统计分析。结果 2016年共分离病原菌5 406株,其中革兰阴性菌共4 020株,占74.4%(4 020/5 406),革兰阳性菌1 386株,占25.6%(1 386/5 406)。细菌主要来源于呼吸道标本和尿液标本,呼吸道标本1 913株,占35.4%(1 913/5 406),尿液标本1 441株,占26.7%(1 441/5 406)。根据分离菌种类分类,以大肠埃希菌检出最多,占23.1%(1 247/5 406),其次为肺炎克雷伯菌,占12.1%(654/5 406)。检出耐甲氧西林金黄色葡萄球菌(MRSA)166株,占金黄色葡萄球菌的52.2%(166/318);耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)462株,占该菌的80.3%(462/575)。大肠埃希菌、肺炎克雷伯菌中产ESBL菌株745株和200株,分别占各自菌种的59.7%(745/1 247)和30.6%(200/654)。产ESBL株对大多数抗生素耐药率明显高于非产ESBL株。粪肠球菌对万古霉素全部敏感;屎肠球菌中检出少量万古霉素耐药菌株(占0.2%),均分离自尿液标本。全院耐碳青霉烯类细菌共分离出1 046株,占19.3%(1 046/5 406),绝大数肠杆菌科细菌对碳青霉烯类抗生素仍保持高度敏感,其中分离出耐碳青霉烯类细菌主要有鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌,各占41.1%(430/1 046)、17.4%(182/1 046)和12.0%(126/1 046)。不动杆菌属细菌对大多数抗生素仍持较高耐药率。结论细菌耐药性呈增长性趋势,应继续加强临床抗生素使用,严格把握抗生素使用指征,合理使用抗生素。Objective To report the distribution and antibiotic resistance of bacterial strains isolated in the First Affiliated Hospital of Anhui Medical University during 2016 for improving clinical treatment of bacterial infections. Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. The results were interpreted according to the clinical and laboratory standards institute （CLSI） 2015 breakpoints, and analyzed using WHONWT 5.6. Results A total of 5 406 clinical isolates were collected during 2016, of which gram positive organisms accounted for 25.6% （1 386/5 406） and gram negative organisms 74.4% （4 020/5 406）. The strains were mainly isolated from respiratory tract （35.4%,1 913/5 406） and urine （26.7%, 1 441/5 406）. The most frequently isolated microorganisms were E. coli （23.1%, 1 247/5 406）,followed by K. pneumoniae （12.1%,654/5 406）. The prevalence of MRSA was 52.2% （166/318）. The prevalence of MRCNS was 80.3% （462/575）. Of the ESBLs producers,E. coli accounted for 59.7% （745/1 247）, and K. pneumoniae accounted for 30.6%（200/654）. ESBLs-producing strains showed significantly higher resistance rates to most antibiotics than non-ESBLs-producing strains. All the E. faecalis strains were susceptible to vancomycin. A few （0.2%） of the E. faecium strains were resistant to vancomycin, which were all from urine specimens. A total of 1 046 （19.3%, 1 046/5 406） carbapenemresistant strains were isolated. Most Enterobacteriaceae isolates were still highly sensitive to carbapenems. Carbapenem-resistant isolates were mainly A. baumannii （41.1%, 430/1 046）, P. aeruginosa （17.4%, 182/1 046）） and K. pneumoniae （12.0%, 126/1 046）.Most Acinetobacter strains were resistant to most of the antibiotics tested. Conclusions Antimicrobial resistance is increasing in the clinical isolates in this hospital. We should continue to strengthen antimicrobial stewardship, prescribe antibiotics for str

关 键 词：耐药性 抗生素 泛耐药 

分 类 号：R378[医药卫生—病原生物学]