2018年安庆市第一人民医院细菌耐药性监测  

Surveillance of antimicrobial resistance in the First People’s Hospital of Anqing in 2018

作　　者：廖怡 王亚平 汪萍 李小月[1] Liao Yi;Wang Ya-ping;Wang Ping;Li Xiao-yue(Department of Laboratory Medicine,the First People’s Hospital of Anqing,Anqing 246003)

机构地区：[1]安庆市第一人民医院检验科,安庆246003

出　　处：《中国抗生素杂志》2021年第6期589-595,共7页Chinese Journal of Antibiotics

基　　金：安徽省科技计划项目(No.1704f0804035)。

摘　　要：目的了解安庆市第一人民医院2018年临床分离菌株对抗菌药物的耐药性及敏感性。方法采用自动化仪器法或纸片扩散法进行药敏试验,药敏结果按2018年临床和实验室标准化协会(CLSI)标准判读,采用WHONET 5.6软件统计分析。结果2018年共检出962株细菌,其中革兰阳性菌占22.7%(218/962);革兰阴性菌占77.3%(744/962)。革兰阴性菌如大肠埃希菌占24.9%,分离率最高;然后是肺炎克雷伯菌、铜绿假单胞菌,菌株主要分离于呼吸道和分泌物标本,分别占38.6%和22.6%。对革兰阳性菌如耐甲氧西林金黄色葡萄球菌(MRSA)及耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率各占29.4%和91.3%,尚未检出耐利奈唑胺和万古霉素的葡萄球菌。肠球菌属里的粪肠球菌和屎肠球菌各占29.8%和70.2%,目前还没有分离出对万古霉素产生耐药的肠球菌。产ESBL的大肠埃希菌、克雷伯菌属和奇异变形菌检出率各占其菌种的56.8%、44.2%和5.3%。肠杆菌科细菌对碳青霉烯类抗菌药物仍然保持高敏感性,其中肺炎克雷伯菌、肠杆菌属细菌对亚胺培南等碳青霉烯类的耐药率均≤4.8%;铜绿假单胞菌对亚胺培南等碳青霉烯类的耐药率较高,为20.9%,但对左氧氟沙星、环丙沙星、哌拉西林/三唑巴坦、妥布霉素、头孢吡肟、头孢他啶、庆大霉素和阿米卡星的耐药率均<25%;鲍曼不动杆菌对亚胺培南等碳青霉烯类抗生素的耐药率为78.9%,对除阿米卡星、米诺环素以外的抗菌药物的耐药率均>65%。结论该院主要临床分离细菌对常用抗菌药物呈现不同程度耐药,应加强医院感控措施,细菌室专业人员应做好细菌耐药监测工作,加强与临床医师的沟通,指导临床合理使用抗菌药物,采取有效措施防治耐药菌株的广泛传播。Objective To investigate the antibiotic resistance of clinical isolates in the First People’s Hospital of Anqing in 2018. Methods The antimicrobial susceptibility testing was carried out according to a unified protocol using automated systems or the Kirby-Bauer method. Results were interpreted according to CLSI 2018 breakpoints and analyzed by WHONET 5.6 software. Results A total of 962 bacterial isolates were collected in 2018. There were 218 strains(22.7%) of Gram-positive bacteria and 744 strains(77.3%) of Gram-negative bacteria. The most frequently isolated bacteria were Escherichia coli(24.9%), followed by Klebsiella pneumoniae, and Pseudomonas aeruginosa. The strains were mainly isolated from the respiratory tract(38.6%) and secretion(22.6%). The prevalence of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus(MRSA and MRCNS) was 29.4% and 91.3%, respectively. No Staphylococcus strains were found resistant to linezolid or vancomycin. Enterococcus faecalis and Enterococcus faecium accounted for 29.8% and 70.2% of total Enterococcus isolates. No Enterococcus strains were found resistant to vancomycin. The prevalence of ESBLs-producing strains was 56.8% in E. coli, 44.2% in Klebsiella spp., and 5.3% in Proteus mirabilis. Enterobacteriaceae strains were still highly susceptible to carbapenems. The resistance rates of Klebsiella pneumoniae and Enterobacteriaceae to imipenem were lower than 4.8%. The resistance rate of P. aeruginosa to imipenem was 20.9%, but lower than 25% to levofloxacin,ciprofloxacin, piperacillin-tazobactam, tobramycin, cefepime, ceftazidime, gentamycin, and amikacin. The resistance rate of Acinetobacter baumannii to imipenem was 78.9%, and the resistance rates to all the antibiotics tested except amikacin and minocycline were higher than 65%. Conclusion The clinical bacterial isolates show various levels of resistance to antibacterial agents. More attention should be paid to infection control measures. The communication between laborator

关 键 词：药敏试验 耐药性监测 抗菌药物 肠杆菌科细菌 

分 类 号：R978.1[医药卫生—药品]