2020年—2023年广州某三甲医院主要细菌耐药率变迁分析  

Analysis of Changes in Major Bacterial Resistance Rates in a Third Class Hospital in Guangzhou from 2020 to 2023

作　　者：冯文强 陈碧霞 Feng Wen-qiang;Chen Bi-xia(Department of Laboratory Medicine,Guangzhou Red Cross Hospital,Guangzhou 510000)

机构地区：[1]广州市红十字会医院检验科,广州510000

出　　处：《国外医药(抗生素分册)》2025年第1期52-58,共7页World Notes on Antibiotics

摘　　要：目的分析我院检出细菌耐药情况、医院感染控制指标及其标本送检情况,提出用药预警及抗菌药物选用建议,控制多重耐药菌院内感染流行暴发。方法收集2020年1月—2023年12月我院微生物室的细菌培养及药敏试验数据,采用Whonet 5.6软件,根据美国临床和实验室标准化协会(CLSI)更新标准,分析细菌体外药物敏感性试验数据。结果2020年—2023年间微生物室分离非重复菌株27176株,其中革兰阴性菌占68.2%(18534/27176),革兰阳性菌占31.8%(8642/27176)。分离菌在各类标本中的分布,呼吸道标本占40.1%,尿液标本占28.6%,分泌物标本占17.2%,血液标本占7.8%,以及其他种类标本(脑脊液、胸水和胆汁等)占6.3%。检出率前五位的分别是大肠埃希菌(19.42%)、肺炎克雷伯菌(12.08%)、铜绿假单胞菌(9.67%)、金黄色葡萄球菌(8.62%)和鲍曼不动杆菌(7.54%)。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为41.8%(981/2346),未发现万古霉素、替考拉宁和利奈唑胺耐药菌株。屎肠球菌相比粪肠球菌,对常用抗菌药物的耐药率明显升高,2023年对万古霉素耐药率为15.5%,替考拉宁耐药率13%,未发现利奈唑胺耐药菌株。耐碳青霉素烯类药物肠杆菌目以肺炎克雷伯菌为主,2023年对美罗培南的耐药率为37.6%。非发酵菌中耐碳青霉烯类药物以鲍曼不动杆菌和铜绿假单胞菌为主,2023年对美罗培南的耐药率分别为72.1%和15.6%。耐碳青霉烯类药物菌株主要分布在重症医学科、神经外科、神经内科和急诊科等。结论2020年—2023年间我院分离的多重耐药菌检出率较高,应加强监测和防控,无菌部位标本占比不高,应努力提高无菌标本送检率,加强重点科室病原菌监测,合理使用抗菌药物。Objective To investigate bacterial resistance detection,hospital infection control indicators,and specimen submission at our hospital,propose medication warnings and antibiotic selection suggestions,and control the hospital's multidrug resistant bacteria outbreak.Method Collect bacterial culture and drug sensitivity test data from our hospital’s microbiology laboratory from January 2020 to December 2023.Use Whonet 5.6 software and analyze bacterial in vitro drug sensitivity test data according to the updated standards of the Clinical and Laboratory Standards Institute(CLSI)in the United States.Results From 2020 to 2023,27176 non repetitive strains were isolated from the microbiology laboratory,of which 68.2%(18534/27176)were Gram negative bacteria and 31.8%(8642/27176)were Gram positive bacteria.The distribution of isolated bacteria in various specimens is as follows:respiratory specimens account for 40.1%,urine specimens account for 28.6%,secretion specimens account for 17.2%,blood specimens account for 7.8%,and other types of specimens(cerebrospinal fluid,pleural fluid,bile,etc.)account for 6.3%.The top five detection rates are Escherichia coli(19.42%),Klebsiella pneumoniae(12.08%),Pseudomonas aeruginosa(9.67%),Staphylococcus aureus(8.62%),and Acinetobacter baumannii(7.54%).The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was 41.8%(981/2346),and no vancomycin,teicoplanin,or linezolid resistant strains were found.Compared with Enterococcus faecalis,Enterococcus faecalis has a significantly higher resistance rate to commonly used antibiotics,with a resistance rate of 15.5%to vancomycin and 13%to teicoplanin in 2023.No linezolid resistant strains were found.The carbapenem resistant Enterobacteriaceae is mainly composed of Klebsiella pneumoniae,with a resistance rate of 37.6%to meropenem in 2023.With resistance rates of 72.1%and 15.6%to meropenem in 2023,respectively,carbapenems are primarily resistant to Acinetobacter baumannii and Pseudomonas aeruginosa among non-fermenting bacteria.The st

关 键 词：菌株 细菌耐药 药物敏感性试验 监测 送检率 抗菌药物 

分 类 号：R978[医药卫生—药品]