2019年某综合性医院细菌耐药监测数据分析  

Analysis of bacterial resistance surveillance data in a large general hospital in 2019

作　　者：邓劲[1] 杨锦华 康梅[1] Deng Jin;Yang Jin-hua;Kang Mei(Department of Clinical Mircrobiology,West China Hospital,Chengdu 610041;Cangxi People's Hospital,Guangyuan 628400)

机构地区：[1]四川大学华西医院实验医学科临床微生物室,成都610041 [2]苍溪县人民医院检验科,广元628400

出　　处：《中国抗生素杂志》2022年第4期405-411,共7页Chinese Journal of Antibiotics

摘　　要：目的分析某综合性医院微生物标本送检情况,临床微生物室标本细菌的分布及耐药情况,给予临床医师对感染性疾病的预防与抗菌药物的使用提供依据。方法回顾病史纳入数据分析,选取2019年1月1日至2019年12月31日临床送检微生物标本,分析细菌分离菌株的分布,采用WHONET 5.6软件,根据美国临床和实验室标准化协会(CLSI)2020更新标准,分析细菌体外药敏实验数据。结果2019年微生物室分离非重复菌株15908例,以革兰阴性菌为主,占68.7%(10938/15908),常见分离菌株前5位依次是大肠埃希菌15.2%(2426/15908)、肺炎克雷伯菌12.3%(1958/15908)、鲍曼不动杆菌9.3%(1482/15908)、金黄色葡萄球菌9.1%(1453/15908)和铜绿假单胞菌8.4%(1337/15908);分离菌在各类标本中的分布,呼吸道标本占约36.8%(5857/15908)、尿液标本占约17.8%(2826/15908)、伤口分泌物标本占约16.0%(2544/15908)、血液标本占约12.0%(1912/15908)以及其他无菌体液标本(脑脊液、胸腹水、胆汁)占约16.7%(2659/15908);多重耐药菌方面,产超广谱β-内酰胺酶的大肠埃希菌(ESBL-E.coil)和肺炎克雷伯菌(ESBL-K.pn)检出率分别为56.4%和47.2%,耐碳青霉烯鲍曼不动杆菌(CRAB)检出率为61.2%,耐碳青霉烯肺炎克雷伯菌(CRKP)检出率为16.2%,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为27.6%,耐万古霉素肠球菌(VRE)为1.3%。结论本院在2019年微生物标本分离病原菌数量及种类较多,耐药细菌同2018年相比,耐碳青霉烯类肠杆菌检出率有所下降,但甲氧西林(苯唑西林)耐药的金黄色葡萄球菌(MRSA)检出率升高较为明显,临床医生在治疗过程中抗生素选择性有限,应根据实验室药敏结果及时更改治疗方案;院感工作者应加强感染管理,并监测耐药细菌的分布变化和临床医生抗菌药物使用情况,从而控制和减少院内感染的风险。Objective To analyze the status of microbiological specimens submitted for examination in a large general hospital,the distribution of bacteria in the clinical microbiology lab and the drug resistance,and to provide clinicians with evidence for the prevention of infectious diseases and the use of antibacterial drugs.Methods The medical history was reviewed and included in the data analysis.The microbial specimens submitted for clinical examination from January 1,2019 to December 31,2019 were selected to analyze the distribution of bacterial isolates.The WHONET 5.6 software was used to analyze the in vitro bacterial drug susceptibility test data.Results In 2019,15,908 cases of non-repetitive strains were isolated in the microbiology lab,with Gram-negative bacteria as the mainstay,accounting for 68.7%(10,938/15,908).The top five commonly isolated strains were Escherichia coli(15.2%,2,426/15,908),Klebsiella pneumoniae(12.3%,1,958/15,908),Acinetobacter baumannii(9.3%,1,482/15,908),Staphylococcus aureus(9.1%,1,453/15,908),and Pseudomonas aeruginosa(8.4%,1,337/15,908).The distribution of isolates in various specimen was as follows.Respiratory tract specimens accounted for about 36.8%(5,857/15,908),urine specimens accounted for about 17.8%(2826/15908),wound secretion specimens accounted for about 16.0%(2544/15,908),blood samples accounted for about 12.0%(1,912/15,908),and other sterile body fluid samples(cerebrospinal fluid,pleural and ascites,bile)accounted for about 16.7%(2,659/15,908).For multi-drug resistant bacteria,they produce extended-spectrumβ-lactamase.The detection rates of extended-spectrumβ-lactamaseproducing Escherichia coli(ESBL-E.coil)and extended-spectrumβ-lactamase-producing Klebsiella pneumoniae(ESBL-K.pn)were 56.4% and 47.2%,respectively.The detection rate of Carbapenem-resistant Acinetobacter baumannii(CRAB)was 61.2%.The detection rate of carbapenem-resistant Klebsiella pneumoniae(CRKP)was 16.2%.The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was 27.6%,and the detection rat

关 键 词：细菌耐药性监测 耐药率 抗菌药物 多重耐药菌 

分 类 号：R978.1[医药卫生—药品]