临床常见病原菌对喹诺酮类抗菌药物的耐药性分析  

Analysis of resistance of common pathogenic bacteria to quinolone antimicrobial agents

作　　者：吕红玲[1] 刘春林[1] 邓德耀[1] 徐红云[1] LYU Hongling;LIU Chunlin;DENG Deyao;XU Hongyun(Department of Clinical Laboratory,the Second People′s Hospital of Yunnan Province/Affiliated Hospital of Yunnan University,Kunming,Yunnan 650000,China)

机构地区：[1]云南省第二人民医院/云南大学附属医院检验科,云南昆明650000

出　　处：《检验医学与临床》2021年第21期3148-3152,3156,共6页Laboratory Medicine and Clinic

摘　　要：目的探讨该院临床常见病原菌的菌群分布及对喹诺酮类抗菌药物的耐药性,指导临床合理使用抗菌药物。方法对2015-2019年该院住院及门诊患者临床感染标本进行病原菌培养,采用VITEK 2 Compact系统进行细菌菌种鉴定、药敏试验,采用WHONET5.6软件进行数据统计分析。结果5年内共分离到27663株非重复致病菌株,其中革兰阴性菌20931株(75.66%),革兰阳性菌6732株(24.34%)。菌株主要来源于痰、创口分泌物/组织、血液和尿液等临床标本。药敏试验结果显示,喹诺酮类抗菌药物耐药率最高的前3位细菌分别为屎肠球菌、鲍曼不动杆菌和大肠埃希菌;产碳青霉烯酶和产超广谱β-内酰胺酶的大肠埃希菌、肺炎克雷伯菌对2种喹诺酮类抗菌药物(环丙沙星和左氧氟沙星)的耐药率均高于不产酶菌株(P<0.01);耐甲氧西林的葡萄球菌对3种喹诺酮类抗菌药物(环丙沙星、左氧氟沙星和莫西沙星)的耐药率明显高于甲氧西林敏感菌株(P<0.01)。结论临床分离的常见病原菌对喹诺酮类抗菌药物的耐药性差异较大,应加强细菌耐药性及产酶菌株的监测,加强抗菌药物管理,减少耐药菌株的产生和传播。Objective To investigate the distribution of common pathogens in the hospital and their resistance to quinolone antibacterial drugs,and to guide the rational use of antibacterial drugs in clinical practice.Methods The pathogenic bacteria were cultured on the clinical infection specimens of inpatients and outpatients in the hospital from 2015 to 2019.The VITEK 2 Compact system was used for bacterial species identification and drug susceptibility tests,and the WHONET5.6 software was used for statistical analysis of data.Results A total of 27663 non-repetitive pathogens were isolated within five years,including 20931 strains of gram-negative bacteria accounted for 75.66%,and 6732 strains of gram-positive bacteria accounted for 24.34%.The strains were mainly derived from clinical specimens such as sputum,wound secretions/tissues,blood and urine.The drug susceptibility results showed that the top three bacteria with the highest resistance rate of quinolone antimicrobials were Enterococcus faecium,Acinetobacter baumannii and Escherichia coli.The resistance rates of Escherichia coli and Klebsiella pneumoniae producing carbapenemase and superbroad spectrumβ-lactamase to two quinolone antibiotics(ciprofloxacin and levofloxacin)were signifecantly higher than those of non-producing enzyme strains(P<0.01).The resistance rates of methoxicillin-resistant staphylococci to three quinolones antibiotics(ciprofloxacin,levofloxacin and moxifloxacin)were significantly higher than those of methoxicillin-sensitive strains(P<0.01).Conclusion The common pathogens isolated from clinical isolates have different resistance to quinolone antibiotics.The monitoring of bacterial resistance and enzyme-producing strains should be strengthened,the management of antimicrobial drugs should be strengthened,and the generation and transmission of drug-resistant strains should be reduced.

关 键 词：病原菌 喹诺酮类药物 耐药性 

分 类 号：R446.5[医药卫生—诊断学]