2016年宁波某三甲医院病原菌分布及耐药性监测分析  

The analysis of the surveillance of resistance and the distribution of bacteria in a 3A grade hospital of Ningbo in 2016

作　　者：王铮铮[1] 许小敏[1] Wang Zheng-zheng;Xu Xiao-min(Department of Clinical Laboratory,Department of Infection Control,Ningbo No.2 Hospital,Ningbo 315000)

机构地区：[1]宁波市第二医院检验科宁波市第二医院院感科,宁波315000

出　　处：《中国抗生素杂志》2018年第10期1232-1237,共6页Chinese Journal of Antibiotics

摘　　要：目的了解我院2016年病原菌的分布及耐药情况,为临床抗感染治疗提供参考。方法按照统一方案,采用自动化仪器法与纸片扩散法相结合,进行体外抗菌药物敏感性试验,采用美国临床实验室标准化研究协会(CLSI) 2016年标准进行结果判读,WHONET 5.6软件进行数据统计。结果剔除同一患者同一部位分离的重复菌株,共5317株细菌,其中革兰阳性菌1495株(28.1%),革兰阴性菌3391株(63.8%)。革兰阳性菌中分离率在前3位的是金黄色葡萄球菌、表皮葡萄球菌、屎肠球菌。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为62.5%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为72.2%,未发现对万古霉素、利奈唑胺耐药的菌株。粪肠球菌和屎肠球菌对利奈唑胺的耐药率分别为6.2%和0.6%,未发现有对万古霉素耐药的肠球菌菌株。β-溶血链球菌和肺炎链球菌对青霉素的敏感率达到100%。革兰阴性菌中排前3位的是大肠埃希菌830株(24.5%)、铜绿假单胞菌670株(19.8%)、肺炎克雷伯菌548株(16.2%)。大肠埃希菌对喹诺酮类的耐药率超过60%,在头孢菌素中对头孢曲松的耐药率最高,接近60%;克雷伯菌属对头孢菌素类的耐药率均低于40%,对喹诺酮类则低于25%,但其对亚胺培南和厄他培南的耐药率分别为9%和11.1%,呈明显上升趋势;耐碳青霉烯类铜绿假单胞菌和鲍曼不动杆菌的检出率分别为41.9%和52.3%,同比2015年有所增高;除氨基糖苷类与头孢哌酮/舒巴坦以外,鲍曼不动杆菌对大多数抗菌药物的耐药率均在50%以上。结论临床分离菌对抗菌药物的耐药率依然呈增长趋势,应加强抗菌药物管理,采取有效的医院感染防控措施来遏制耐药菌的传播,并认真做好细菌耐药性监测工作为临床初始经验性治疗提供依据。Objective To investigate the resistance and distribution of bacteria in our hospital in 2016 and provide a reference for clinical anti-infectious therapy. Methods The in vitro antimicrobial susceptibility testing was performed by automated systems in combination with the Kirby-Bauer method according to the standard protocol. The statistical data were analyzed by the WHONET 5.6 software based on the CLSI 2016 breakpoints. Results A total of 5,317 strains of bacteria were collected by adopting the first-time isolates from patients, of which Gram-positive and Gram-negative strains accounted for 28.1% （1,495/5,317） and 63.8% （3,391/5,317）, respectively. The top three most frequently isolated Gram-positive bacteria were S. aureus, S. epidermidis, and E. faecium. Methicillin- resistant strains in S. aureus （MRSA） and coagulase-negative Staphylococcus （MRCNS） accounted for 62.5% and 72.2% respectively, and no staphylococcal strains were found resistant to vancomycin or linezolid. The resistant rates to linezolid ofE. faecalis and E. faecium strains were 6.2% and 0.6% respectively, and in Enterococcus spp., there were no strains found resistant to vancomycin. The susceptible rates of both strains of beta-hemolytic Streptococcus and Str.pneumoniae to penicillin were 100%. The top three most frequently isolated Gram-negative bacteria were Escherichia coli （830 strains, 24.5%）, Pseudomonas aeruginosa （670 strains, 19.8%）, and Klebsiella pneumoniae （548 strains, 16.2%）. The resistant rate orE. coli to quinolones was over 60%, to ceflriaxone was close to 60%, which was higher than any other cephalosporins; the resistant rates ofKlebsiella spp. to cepholosporins were all lower than 40%, and to quinolones were all lower than 25%. However, about 9% and 11.1% ofKlebsiella spp., showing the increasing trend obviously, were resistant to imipenem and ertapenem respectively. The resistant rates ofPseudomonas aeruginosa and Aeinetobacter baumannii strains to carbapenems were 41.9% and 52.3% respectively, wh

关 键 词：细菌耐药性监测 抗菌药物敏感性试验 耐药率 

分 类 号：R378[医药卫生—病原生物学] R978.1[医药卫生—基础医学]