2013—2017年重庆某二级医院血流感染细菌耐药性监测  

Surveillance of bacterial resistance of pathogens isolated from bloodstream infections of a second-class hospital in Chongqing between 2013 and 2017

作　　者：夏静 Xia Jing(Department of Laboratory Medicine,the Thirteenth People's Hospital of Chongqing,Chongqing 400053)

机构地区：[1]重庆市第十三人民医院医学检验科

出　　处：《中国抗生素杂志》2019年第10期1203-1208,共6页Chinese Journal of Antibiotics

摘　　要：目的了解重庆某二级医院血流感染分离菌对临床常用抗菌药物的敏感性和耐药性。方法临床分离细菌采用最低抑菌浓度(minimal inhibitory concentration,MIC)法进行细菌药物敏感试验,结果按美国临床实验室标准化研究协会(CLSI)2017年版标准判断。结果2013年1月—2017年12月收集此院临床分离菌共3067株,其中革兰阳性菌占37.4%,革兰阴性菌占62.6%。5年期间,除2014年外耐甲氧西林金黄色葡萄菌(MRSA)分离率逐年下降,从36.1%降为22.6%。未发现万古霉素耐药株。肠球菌属细菌中粪肠球菌对多数主要抗菌药物耐药率均低于屎肠球菌,屎肠球菌出现少数万古霉素耐药株(2.9%)。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,多数菌属的耐药率低于10.0%(克雷伯菌属细菌除外)。大肠埃希菌和肺炎克雷伯菌中ESBLs分离率均值分别为48%和19.6%。肺炎克雷伯菌对厄他培南及亚胺培南都出现了耐药率升高,从2013年的2.2%和0分别上升到了2017年的14.5%和12.9%。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为28.1%和19.3%,鲍曼不动杆菌对两者的耐药率均是67.3%。结论血流感染细菌耐药性严重,对主要抗菌药物耐药率居高不下,尤其是耐碳青霉烯肺炎克雷伯菌已对临床构成严重威胁。合理选用抗菌药物,加强感染控制是当务之急。Objective To investigate the antimicrobial resistance profile of clinical isolates from bloodstream infections to common antibiotics in a second-class hospital in Chongqing.Methods The clinical isolate were tested by MIC method according to the unified plan,and the results were judged according to the standard of CLSI 2017 edition.Results A total of 3,067 clinical isolates were collected from January 2013 to December 2017,of which Gram-positive cocci accounted for 37.4%and Gram-negative organisms accounted for 62.6%.During the five years except the year 2014,the prevalence of methicillin resistant strains(MRSA)decreased year by year,from 36.1%to 22.6%.No staphylococcal strains were found resistant to vancomycin.E.faecalis strains showed lower resistance rates to most of the drugs tested than E.faecium.Vancomycin-resistant Enterococcus(VRE)was identified in E.faecium.Enterobacteriaceae strains were still highly susceptible to carbapenems.Overall,less than 10%of these strains(excluding Klebsiella spp.)were resistant to carbapenems.The ESBLs strains of Escherichia coli and Klebsiella pneumoniae were 48%and 19.6%,respectively.The prevalence of ertapenem-resistant K.pneumoniae increased from 2.2%in 2005 to 14.5%in 2017,and imipenem-resistant K.pneumoniae increased from 0 in 2005 to 12.9%in 2017.The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 28.1%and 1.3%,respectively,and the resistance rates of Acinetobacter baumanii to both were 67.3%.Conclusion Bacterial resistance of pathogens isolated from bloodstream infections is serious and still on the rise,especially for the carbapenemresistant K.pneumoniae,which is a serious threat to clinical constitution.It is urgent to choose antibiotics rationally and strengthen infection control measures.

关 键 词：血流感染 细菌耐药性监测 细菌药物敏感试验 耐碳青霉烯类革兰阴性菌 

分 类 号：R978.1[医药卫生—药品]