肾移植患者病原菌分布及耐药性监测的单中心分析  

Single center analysis of pathogen distribution and drug resistance monitoring in renal transplantation patients

作　　者：雷金娥[1] 马晨[1] 张祎[1] 李芳[1] 丁小明[2] 薛武军[2] 田普训[2] 徐纪如 Lei Jine;Ma Chen;Zhang Yi;Li Fang;Ding Xiaoming;Xue Xiaoming;Xue Wujun;Tian Puxun;Xu Jiru(Clinical Laboratory,The First Affiliated Hospital of Xi＇an Jiaotong University,Xi＇an 710061,Shaanxi,China;Renal Transplantation,The First Affiliated Hospital of Xi＇an Jiaotong University,Xi＇an 710061,Shaanxi,China;Department of Pathogenic Microorganisms and Immune,Xi＇an Jiaotong University,Xi＇an 710061,Shaanxi,China)

机构地区：[1]西安交通大学第一附属医院检验科,陕西西安710061 [2]西安交通大学第一附属医院肾脏病医院肾移植科,陕西西安710061 [3]西安交通大学医学院病原微生物与免疫学系,陕西西安710061

出　　处：《实用器官移植电子杂志》2018年第3期177-182,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：陕西省科技攻关项目(2017SF-198)

摘　　要：目的了解西安交通大第一附属医院肾移植病区近5年微生物标本送检、分离菌分布及临床主要分离菌对常用抗菌药物的敏感性和耐药性。方法对肾移植病区2013—2017年临床标本常规培养鉴定,采用自动化仪器法或纸片扩散法进行抗菌药物敏感性试验。结果共送检培养标本7 530份,其中尿液2 521份(33.5%),引流液2 299份(30.5%),血标本1 187份(15.8%),其他标本1 523份(20.2%),包括痰液、胸腹腔积液、腹透液及脓液等;共检出分离菌1 536株,非重复分离菌648株,其中细菌590株(91.0%)、真菌58株(9.0%),位于前5位的细菌分别为屎肠球菌(19.8%)、大肠埃希菌(15.6%)、肺炎克雷伯菌(8.3%)、铜绿假单胞菌(4.6%)及鲍曼不动杆菌(4.5%),分离的真菌以白色念珠菌和近平滑念珠菌为主(46.4%),不同的标本类型分离菌分布有差异;肠杆菌科中大肠埃希菌和肺炎克雷伯菌产超广谱β0内酰胺酶菌株(ESBLs)检出率分别为89.1%和71.7%,碳青霉烯类耐药肠杆菌科细菌(CRE)平均检出率为8.2%,以弗劳地枸橼酸杆菌和产酸克雷伯菌为主;非发酵菌中鲍曼不动杆菌和铜绿假单胞菌对亚胺培南的耐药率分别为69.0%和23.3%;葡萄球菌中金黄色葡萄球菌和表皮葡萄球菌甲氧西林耐药株的检出率分别为78.6%和93.3%,未发现万古霉素和利奈唑胺耐药菌株;肠球菌属中粪肠球菌对多数测试抗菌药物(四环素除外)的耐药率均显著低于屎肠球菌,两者中均未发现万古霉素耐药株。结论临床分离菌对常用抗菌药物的耐药率仍然偏高,尤其CRE检出有逐年增加的趋势,应加强医院感染防控措施和抗菌药物的合理使用,避免耐药菌的增加及扩散。Objective To investigate the susceptibility profile of clinical isolates collected from renal transplant ward in a teaching hospital in 2013-2017. Methods Antimicrobial susceptibility testing was using Kirby-Bauer method or automated systems. Results were analyzed according to CLSI 2017 breakpoints. ResultsA total number of 7 530 clinical specimens were collected from renal transplant unit in 2013—2017,including urine 2 521（33.5%）,drainage of liquid 2 299（30.5%）, blood specimens 1 187（15.8%）, other 1 523（20.2%）. A total number of 1 536 isolates,648 isolates not repeated, 590 strains（91.0%） was bacteria,58 strains（9.0%）was fungi, the top five isolates were Enterococcus faecium（19.8%）, Escherichia coli（15.6%）, Klebsiella pneumoniae（8.3%）, Pseudomonas aeruginosa（4.6%） and Acinetobacter baumannii（4.5%）, respectively. Separation of fungi is given priority to with Candida albicans and Candida glabrata（46.4%）. Prevalence of ESBLs-producing strains was 89.1% in Escherichia coli,71.7% in Klebsiella pneumoniae,8.2% of these strains were resistant to carbapenems. The resistant rate of 69.0% to Pseudomonas aeruginosa and 23.3% to Acinetobacter baumannii, respectively. The overall prevalence of methicillin-resistant strains was 78.6% in Staphylococcus aureus and 93.3% in Staphylococcus epidermidis, respectively. No staphylococcal strains were found resistant to vancomycin. The resistance rates of Enterococcus faecalis strains to most drugs tested（except tetracyclines） were much lower than those of Enterococcus faecium. No strains of both species were resistant to vancomycin Conclusion Bacterial resistance to commonly used antibiotics is still on the rise, especially the Carbapenem-resistant Enterobacteriaceae（CRE） isolates has a tendency to increase year by year. It is necessary to strengthen hospital infection control and management of clinical use of antimicrobial agents, and maintain good practice in surveillance of bacterial resistance.

关 键 词：细菌耐药性监测 药物敏感性试验 细菌甲氧西林耐药葡萄球菌 碳青霉烯类耐药肠杆菌科 

分 类 号：R446.5[医药卫生—诊断学] R699.2[医药卫生—临床医学]