县级医院临床常见细菌耐药性分析及抗菌药物应用合理性调查  

Drug resistance analysis of common clinical bacteria in county-level hospitals and investigation of rationality of antimicrobial application

作　　者：莫双铭 唐钰书 游海涛[1] MO Shuang-ming;TANG Yu-shu;YOU Hai-tao(Pharmacy,Peoples's Hospital of Yuechi County,Yuechi,Sichuan 638300,China;不详)

机构地区：[1]岳池县人民医院药剂科,四川岳池638300 [2]川北医学院第二临床学院肾内科,四川南充637001

出　　处：《中国卫生检验杂志》2022年第17期2138-2142,2146,共6页Chinese Journal of Health Laboratory Technology

基　　金：川北医学院2021年度四川省基层卫生事业发展研究中心资助项目(SWFZ21-C-86)。

摘　　要：目的基于某医院抗菌药物耐药监测,确定常见致病菌分离株及其抗菌药物敏感性特征。方法使用来自广安某三甲医院7年间抗菌药物药敏试验记录进行横断面回顾性研究,对纳入统计的9545株细菌药敏结果进行分析。结果革兰阳性菌占32.0%,革兰阴性菌占68.0%,革兰阳性菌中以金黄色葡萄球菌为主,其次是肺炎链球菌;革兰阴性菌以大肠埃希菌为主,其次是流感嗜血杆菌。药敏结果显示,MRSA和MRCNS检出率分别为41.8%和78.3%。肠球菌属中,粪肠球菌对喹诺酮类抗菌药物耐药率低于屎肠球菌,两者尚未发现利奈唑胺耐药株。肠杆菌属中产ESBLs的大肠埃希菌和肺炎克雷伯菌检出率分别为21.6%和57.9%。过去7年监测显示,MRSA对左氧氟沙星敏感率下降;流感嗜血杆菌对阿莫西林/克拉维酸敏感率上升;肺炎链球菌对美罗培南敏感率上升。结论临床分离菌株对常见抗菌药物的耐药率呈水平趋势,但如MRSA对左氧氟沙星耐药呈直线上升趋势,提示该院需要加强广谱抗菌药物管理,规范临床合理使用抗菌药物,加强预防感染措施,减缓细菌耐药。Objective Based on a hospital antibiotic resistance surveillance,identify common pathogenic strains and their antibiotic sensitivity characteristics.Methods A cross-sectional retrospective study was conducted using the records of antimicrobial susceptibility testing of a tertiary hospital in Guang’an City for 7 years,and the antimicrobial susceptibility results of 9545bacterial strains included in the statistics were analyzed.Results Gram-positive bacteria and Gram-negative bacteria accounted for 32.0%and 68.0%,and S.aureus was the main gram-positive bacteria,followed by S.pneumoniae;Gram-negative bacteria were mainly E.coli,followed by H.influenzae.The results showed that the detection rates of methicillin-resistant S.aureus(MRSA)and methicillin-resistant coagulase-negative staphylococci(MRCNS)were 41.8%and78.3%.Among the Enterococcus genus,the resistance rate of E.faecalis to quinolone antibiotics was significantly lower than that of E.faecium,and no linezolid-resistant strains were found.The detection rates of Extended-spectrumβ-lactamase(ESBLs)-producing E.coli and K.pneumoniae in Enterobacteriaceae were 21.6%and 57.9%.The 7-year monitoring showed that the sensitivity rate of MRSA to levofloxacin decreased;the sensitivity rate of H.influenzae to amoxicillin/clavulanate increased;and the susceptibility rate of S.pneumoniae to meropenem increased.Conclusion The resistance rate of clinical isolates to common antibiotics showed a horizontal trend,but the resistance rate of MRSA to levofloxacin showed a linear upward trend,suggesting that the hospital needs to strengthen the management of antibiotics,standardize rational use of drugs,strengthen infection prevention measures,and slow down bacterial resistance.

关 键 词：细菌耐药监测 抗菌药物 甲氧西林耐药金黄色葡萄球菌 

分 类 号：R37[医药卫生—病原生物学]