临床分离菌株耐药性回顾分析  

Retrospective analysis of drug resistance of clinical isolates

作　　者：朱琼芳[1] 徐杰[1] 张险峰[1] 陈旭[1] 任亚璐[1] 赵丽娜[1] Zhu Qiongfang;Xu Jie;Zhang Xianfeng;Chen Xu;Ren Yalu;Zhao Lina(Center for Clinical Laboratory,The First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院临床检测中心,江苏苏州215006

出　　处：《右江民族医学院学报》2020年第4期413-418,共6页Journal of Youjiang Medical University for Nationalities

基　　金：国家自然科学基金青年科学基金项目(81702065);江苏省自然科学基金青年基金项目(BK20170364);江苏省青年医学重点人才(QNRC2016726)。

摘　　要：目的探讨苏州大学附属第一医院2018年患者临床分离菌株对常用抗菌药物的敏感性和耐药性,为临床合理用药提供理论参考和依据。方法收集2018年本院门诊及住院患者送检的各种微生物标本,接种培养分纯后,采用自动化仪器和纸片扩散法进行细菌体外药敏试验,按照美国临床和实验室标准化协会(CLSI)2018年标准判读药敏结果,并用WHONET 5.6软件进行统计分析。结果共分离出8402株非重复菌株,其中革兰阳性菌2236株,占26.61%,革兰阴性菌6166株,占73.39%。临床分离菌株前5位分别为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌和鲍曼不动杆菌。临床送检标本中血液标本占25.92%,痰液标本占22.23%,尿液标本占19.18%。耐甲氧西林的金黄色葡萄球菌(MRSA)和耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)的检出率分别为52.54%和83.06%。MRSA中有96.31%菌株对甲氧苄啶-磺胺甲唑敏感;MRCNS中有76.32%的菌株对四环素敏感。屎肠球菌对多数测试抗菌药物(除外四环素)的耐药率均显著高于粪肠球菌。除肺炎克雷伯菌外,多数肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,耐药率低于4%;而肺炎克雷伯菌对亚胺培南的耐药率为24.52%。共检出耐碳青霉烯类肺炎克雷伯菌403株,耐碳青霉烯类大肠埃希菌21株,耐碳青霉烯类铜绿假单胞菌315株,耐碳青霉烯类鲍曼不动杆菌561株,多为广泛耐药菌株。结论临床分离菌耐药率呈增长性趋势,尤其是耐碳青霉烯类肺炎克雷伯菌,应多科室协作进一步加强抗菌药物的应用与管理,做好医院感染预防与控制工作。Objective To investigate the susceptibility and resistance to common antimicrobial agents in clinical isolates from patients cared at the First Affiliated Hospital of Soochow University in 2018,so as to provide theoretical reference and evidence for rational use of antibiotics in clinic.Methods Various kinds of microbial specimens from the outpatients and inpatients of the hospital in 2018 were collected and the bacterial drug-sensitivity test in vitro was conducted by automated instrument and Kirby-Baucer disk diffusion method after inoculation culture,isolation and purification.The results were interpreted according to the 2018 Standard of Clinical and Laboratory Standards Institute(CLSI)and were statistically analyzed by the WHONWT 5.6 software.Results A total of 8402 non-repeated strains were isolated out,and gram-positive bacteria accounted for 26.61%of them(2236 strains)and gram-negative bacteria accounted for 73.39%of them(6166 strains).The top five clinical isolates were Klebsiella pneumonia,Escherichia Coli,Pseudomonas aeruginosa,Staphylococcus aureus and Acinetobacter baumannii.Among the clinical specimens,blood specimens accounted for 25.92%,sputum specimens 22.23%,and urine specimens 19.18%.The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)and that of methicillin-resistant coagulase-negative staphylococcus(MRCNS)were 52.54%and 83.06%,respectively.However,96.31%of MRSA strains were susceptible to trimethoprim-sulfamethoxazole,while 76.32%of MRCNS strains were susceptible to tetracycline.The resistant rate of Enterococcus faecium to most tested antibacterial drugs(except for tetracycline)was significantly higher than that of Enterococcus faecalis.Except for Klebsiella pneumoniae,most Enterobacteriaceae bacteria were still highly susceptible to carbapenem antibiotics and the resistant rate was less than 4%.The resistant rate of Klebsiella pneumoniae to imipenem was 24.52%.Altogether 403 strains of carbapenem-resistant Klebsiella pneumonia,21 strains of carbapenem-resistant Escherichi

关 键 词：细菌耐药性监测 体外药敏试验 耐甲氧西林葡萄球菌 耐碳青霉烯类革兰阴性菌 

分 类 号：R446.5[医药卫生—诊断学]