连云港地区6家三级医院2015—2020年细菌耐药性监测  

Surveillance of Bacterial Resistance in 6 Tertiary Hospitals in Lianyungang Region from 2015 to 2020

作　　者：田丽梅[1] 沈茜 金丹婷[1] 茆海丰[1] Tian Li-mei;Sheng Qian;Jin Dan-ting;Mao Hai-Feng(Lianyungang First People's Hospital,Lianyungang 222000;Lianyungang Fourth People's Hospital,Lianyungang 222000)

机构地区：[1]连云港市第一人民医院,连云港222000 [2]连云港市第四人民医院,连云港222000

出　　处：《国外医药（抗生素分册）》2022年第2期134-140,共7页World Notes on Antibiotics

摘　　要：目的 了解连云港地区临床分离菌耐药状况和耐药变化趋势,为本地区细菌耐药的防控和抗菌药物使用提供依据。方法收集该地区6家三级医院2015—2020年6年中临床分离菌药敏数据,依据保留每例患者每种细菌第一株的原则,剔除重复菌株后,用WHONET5.6软件进行统计分析,药敏标准采用美国临床和实验室标准化协会(CLSI)2018年标准。结果 6家三级医院2015—2020年6年中共分离非重复株细菌36953株,来自32446份临床标本。其中革兰阴性菌27021株(占73.2%),革兰阳性菌9932株(占26.9%),占前五位的分离菌为大肠埃希菌(7644株占20.7%),克雷伯菌属(主要为肺炎克雷伯菌6376株占17.3%),铜绿假单胞菌(4651株占12.6%),不动杆菌(主要为鲍曼不动杆菌3790株占10.3%),金黄色葡萄球菌(3105株占8.4%)。革兰阳性球菌中葡萄球菌属耐甲氧西林金黄色葡萄球菌(MRSA)6年总的分离率为46.7%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)总的分离率为76.3%,MRSA的分离率6年间呈下降趋势,而MRCNS的分离率呈上升趋势,同时有少量利奈唑胺耐药凝固酶阴性葡萄球菌检出,未检出耐万古霉素葡萄球菌。肠球菌中屎肠球菌和粪肠球菌的比例分别为54%和40%,而两者对万古霉素的耐药率均为0.3%。肺炎链球菌的青霉素耐药率成人和儿童之间相差不大,均在3%左右。阴性杆菌中大肠埃希菌和肺炎克雷伯菌对三代头孢菌素类药物的耐药率呈逐年下降趋势,分别从2015年的68.7%和57.7%下降到2020年的54.5%和46.8%,而大肠埃希菌对氟喹诺酮类药物的耐药率一直维持在高位(64.%~70.1%),6年变化不大。耐碳青霉烯肠杆菌(CRE)分离率快速上升,由2015的6.0%上升到2020年的12.6%,主要是由于耐碳青霉烯的肺炎克雷伯菌(CRKP)分离率的快速增加,CRKP的分离率由2015的11.1%上升到2020年的22.5%。铜绿假单胞菌对检测的抗菌药物的耐药率在4.8%~30%之间,其中对阿米卡星的耐药率最Objective To understand the status and trend of drug resistance of clinical isolates in Lianyungang area providing evidence for control of bacterial resistance and rational selection of antimicrobial agent.Methods Drug sensitivity data of clinical isolates from 6 tertiary hospitals in the region during the six years from 2015 to 2020 were collected.Eliminating repeated strains,the results testing were interpreted according to CLSI 2018 breakpoints.WHONET 5.6 were used for statistical analysis.Results A total of 36953 strains of non-repeating bacteria were isolated from 32446 clinical specimens in 6 tertiary hospitals from 2015 to 2020.Among them,there were 27021 strains of Gram-negative bacteria (73.2%),9932 strains of gram-positive bacteria (26.9%),the top five isolates were Escherichia coli (7644 strains,20.7%),Klebsiella spp (mainly Klebsiella pneumoniae) (6376 strains,17.3%),and Pseudomonas aeruginosa (4651 strains,12.6%),Acinetobacter spp(mainly Acinetobacter baumannii) (3790 strains,10.3%),Staphylococcus aureus (3105 strains,8.4%).Among gram-positive cocci,the total separation rate of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Coagulase-negative staphylococcus (MRCNS) was 46.7% and 76.3% respectively in 6 years.The separation rate of MRSA decreased in 6 years,while the separation rate of MRCNS increased,a small amount of linezolid resistant coagulase negative staphylococcus was detected,but no vancomycin-resistant staphylococcus was detected.The proportion of Enterococcus faecium and Enterococcus faecalis in enterococcus was 54% and 40%,respectively,and the drug resistance rate of both to vancomycin was 0.3%.The penicillin resistance rate of Streptococcus pneumoniae was not significant between adults and children,which was about 3%.Among the negative bacilli,the drug resistance rates of Escherichia coli and Klebsiella pneumoniae to the third generation of cephalosporin decreased year by year,from 68.7% and 57.7% in 2015 to 54.5% and 46.8% in 2020,respectively,while the drug

关 键 词：细菌耐药性监测 抗菌药物 分离菌 

分 类 号：R978.1[医药卫生—药品]