2018年某三级医院细菌耐药性监测结果分析  

Analysis of bacterial resistance and its results in a tertiary hospital in 2018

作　　者：张世武[1] 王龙 杨淮丽 王自林[3] Zhang Shiwu;Wang Long;Yang Huaili;Wang Zilin(Department of Laboratory,Dongfang Hospital Conglomerate,Huainan 232001,China)

机构地区：[1]安徽淮南东方医院集团总院检验科,淮南232001 [2]安徽淮南东方医院集团总院感控科,淮南232001 [3]安徽淮南东方医院集团总院干保科,淮南232001

出　　处：《中国临床保健杂志》2019年第4期472-476,共5页Chinese Journal of Clinical Healthcare

摘　　要：目的 了解某三级医院2018年临床分离的病原菌分布特点及其对常用抗菌药物的耐药情况,为临床用药提供依据和参考。方法 总共收集门诊和住院患者各类培养标本13499份,经培养分离出1623株非重复有效菌株,采用自动仪器法或纸片扩散法(K-B)对其非重复的1623株进行体外药敏实验,按CLSI2016年版判读药敏结果,采用WHONET5.6软件进行耐药性分析。结果 本院共分离病原菌1623株,其中革兰阴性菌占66.4%(1078),革兰阳性菌占33.6%(545)。10种最常见的细菌分别为:大肠埃希菌(329株),肺炎克雷伯肺炎亚种(252株),铜绿假单胞菌(114株),表皮葡萄球菌(102株),金黄色葡萄球菌(101株),鲍曼氏不动杆菌(100株),人葡萄球菌(80株),溶血性葡萄球菌(69株),粪肠球菌(44株),阴沟肠杆菌(33株)。葡萄球菌中MRSA和MRCNS的检出率分别为11.8%和60.1%,未发现万古霉素和替考拉宁耐药菌株。屎肠球菌对常用抗生素的耐药率明显高于粪肠球菌,其中屎肠球菌和粪肠球菌对万古霉素耐药率分别为7.1%和2.4%,依据表型推测可能为VanA和VanB型耐药。肠杆菌科细菌中,肺炎克雷伯菌对抗菌药物亚胺培南和美罗培南的耐药率分别为22.8%和22.1%,明显高于大肠埃希菌和阴沟肠杆菌等其他肠杆菌科细菌。非发酵菌主要以铜绿假单胞菌和鲍曼氏不动杆菌为主,其中铜绿假单胞菌对氨苄西林、头孢唑啉、哌拉西林/他唑巴坦、氨苄西林/舒巴坦、头孢噻肟、复方新诺明等耐药率达到100%,对亚胺培南和左氧氟沙星的耐药率高达30%以上,鲍曼不动杆菌对左氧氟沙星、环丙沙星、亚胺培南和美罗培南的耐药率高达80%以上,与安徽省2015年细菌耐药监测分析基本一致[1]。结论 临床分离的细菌对抗生素耐药呈逐年增长趋势,尤其多重耐药和泛耐药菌的频繁检出应引起高度重视,更应加强抗菌药物的合理使用和耐药性的监测显得尤为重要。Objective To understand the distribution characteristics of pathogenic bacteria isolated in Huainan Oriental Hospital Group General Hospital in 2018 and their drug resistance to commonly used antibiotics,so as to provide basis and reference for clinical drug use. Method A total of 13 499 culture samples of various kinds were collected from clinical outpatient and inpatient,and 1 623 clinical isolates which were effective and distinct were cultured.The antimicrobial susceptibility tests in vitro about 1 623 distinct strains were tested by the method of Automatic Instrument or disk diffusion method (K-B method) and interpreted drug sensitivity results according to CLSI2016.Referring to WHONET5.6 statistical software analyzed drug resistance. Results A total of 1 623 clinical isolates were collected,among which Gram negative bacteria accounted for 66.4%(1078) and Gram positive bacteria accounted for 33.6%(545).The ten most common types of bacteria were Escherichia coli (329),Subspecies of Klebsiella pneumoniae pneumonia (252),Pseudomonas aeruginosa(114),Staphylococcus epidermidis(102),Staphylococcus aureus(101),Acinetobacter baumannii(100),Staphylococcus hominis(80),Staphylococcus haemolyticus(69),Enterococcus faecalis(44) and Enterobacter cloacae(33).Staphylococcus aureus MRSA and MRCNS detection rates were 11.8% and 60.1% respectively,and no staphylococcus was found to be resistant to vancomycin and teicoplanin.The resistance rate of Enterococcus faecium about commomly used antibiotics was higher than that of Enterococcus faecalis,and the resistance rates of Enterococcus faecium and Enterococcus faecali s about vancomycin of them were 7.1% and 2.4% respectively,which could suspect that they were VanA and VanB which were resistant to vancomycin in terms of phenotype.In Enterobacteriaceae,the resistance rates of Klebsiella pneumonia pneumonia subspecies about imipenem and meropenem were 22.8% and 22.1% respectively,which was apparently higher than Escherichia coli,Enterobacter cloacae and other Enterobacteriaceae.No

关 键 词：抗药性 细菌 药物监测 流行病学研究 

分 类 号：R446.5[医药卫生—诊断学]