2012年至2019年某三级综合医院5种重要临床病原菌的耐药性变迁

目的分析某三级综合医院五种重要临床病原菌的耐药性变迁。方法对2012年1月至2019年12月临床分离菌株,采用纸片扩散法或自动化仪器进行药物敏感性试验,耐药率统计采用WHONET 5.6软件。结果 2012年至2019年临床标本分离出细菌株数在3 633~4 775株之间。8年间,五种临床重要分离病原菌所占比例为59.35%~70.03%。大肠埃希菌检出比例逐年降低,总体耐药率基本稳定;肺炎克雷伯菌对多数所受试抗菌药物耐药率有升高趋势;铜绿假单胞菌对碳青霉烯类耐药率升高;鲍曼不动杆菌对多数抗菌药物的耐药率有升高趋势;甲氧西林耐药金黄色葡萄球菌对利福平、复方新诺明、环丙沙星和庆大霉素的耐药率显著下降,甲氧西林敏感金黄色葡萄球菌对复方新诺明的耐药率显著下降;产超广谱β-内酰胺酶的肺炎克雷伯菌检出率显著升高,亚胺培南耐药的肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌检出率均有上升趋势(P<0.05)。结论肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类的耐药率显著升高,应加强细菌耐药监测和抗菌药物的合理使用。

Resistance trends among five important clinical pathogens in a tertiary general hospital from 2012 to 2019

Objective To investigate the resistance trends of five important clinical pathogens in a tertiary general hospital.Methods The clinical isolates were tested for drug sensitivity by paper diffusion method or automatic instrument from January 2012 to December 2019.WHONET 5.6 software was used for drug resistance rate statistics.Results The number of bacteria isolated from clinical samples was between 3 633 and 4 775 from 2012 to 2019.The proportion of five important clinical pathogens was between 59.35% and 70.03% in 8 years,and the proportion of Escherichia coli was decreasing year by year.The overall resistance rate of Escherichia coli was basically stable,Klebsiella pneumoniae to most of the tested antimicrobial agents showed an increasing trend,Pseudomonas aeruginosa to carbapenem,Acinetobacter baumannii to most of the antimicrobial agents showed an increasing trend.The drug resistance rate of methicillin-resistant Staphylococcus aureus to rifampin,compound minophen,ciprofloxacin and gentamycin decreased significantly,while that of methicillin sensitive Staphylococcus aureus to compound minophen decreased significantly.The detection rate of extended-spectrum β-lactamases producing Klebsiella pneumoniae was increasing significantly.The detection rate of imipenem resistant Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii all increased (P < 0.05).Conclusions The resistance rate of Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter Bauman to carbapenem resistance increased significantly.We should strengthen the monitoring of bacterial resistance and the rational use of antibiotics.