2019年自贡市第一人民医院细菌耐药性监测

目的 了解自贡市第一人民医院2019年临床分离细菌耐药性。方法 收集该院2019年临床菌株及药敏结果，以美国临床和实验室标准化协会(CLSI)2019年折点作为细菌药敏的判断标准，采用WHONET5.6及SPSS23软件对数据进行分析统计。结果 共分离出4189株，其中革兰阳性菌1301株，占31.1%；革兰阴性菌2888株，占68.9%。排名前5位细菌分别为大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、铜绿假单胞菌和肺炎链球菌。分离菌的标本类型以痰液和尿液为主，革兰阳性菌耐药情况：耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为23.1%和81.1%，未发现耐万古霉素或利奈唑胺的菌株；肠球菌属中分离出3株耐利奈唑胺的粪肠球菌，未分离出耐万古霉素的屎肠球菌和粪肠球菌；分离出1株耐青霉素的肺炎链球菌。革兰阴性菌耐药情况：大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗生素高度敏感，耐药率分别为1.1%和3.0%，产超广谱β-内酰胺酶(ESBLs)菌株的检出率分别为39.5%和12.1%；非发酵糖革兰阴性杆菌中，铜绿假单胞菌对常见抗菌药物耐药率低于鲍曼不动杆菌，其中耐碳青霉烯类铜绿假单胞菌和耐碳青霉烯类鲍曼不动杆菌的检出率分别为9.8%和65.8%；流感嗜血菌和黏膜炎莫拉菌多见于儿童，其中产β-内酰胺酶菌株检出率较高，分别为73.4%和97.7%。结论 临床分离菌以革兰阴性菌为主，流感嗜血菌和黏膜炎莫拉菌产β-内酰胺酶比率高；同时鲍曼不动杆菌对碳青霉烯类抗生素耐药率高，医院感染管理部门应采取相应措施，以减少其流行暴发。

Surveillance of antibiotic resistance in clinical isolates in Zigong First People's Hospital in 2019

Objective To understand the clinical isolation of bacterial resistance in Zigong First People’s Hospital in 2019. Methods The clinical strains and antibiotic susceptibility results of the hospital in 2019 were collected, and the American Association for Clinical and Laboratory Standardization (CLSI) 2019 inflection points were used as the judgment standard of bacterial drug sensitivity. WHONET5.6 and SPSS20.0 statistical softwares were used to analyze the data. Results A total of 4189 bacterial strains were isolated, of which 1,301 strains were Gram-positive bacteria (31.1%) and 2,888 strains were Gram-negative bacteria (68.9%). The top five bacteria included Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Streptococcus pneumoniae. Sputum and urine were the main types of isolates. The results of drug resistance surveillance of common Gram-positive bacteria were as follows: the detection rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulastase-negative Staphylococcus (MRCNS) were 23.1% and 81.1%, respectively, and no strains resistant to vancomycin or linezolid were found. Three strains of Enterococcus faecalis resistant to linezolide were isolated, and Enterococcus faecium and Enterococcus faecalis resistant to vancomycin were not isolated. A penicillin-resistant Streptococcus pneumoniae was isolated. The results of drug resistance of common Gram-negative bacteria were as follows: Escherichia coli and Klebsiella pneumoniae were highly sensitive to carbapenem antibiotics, with resistance rates of 1.1% and 3.0% respectively, and the detection rates of extended-spectrum β-lactamases?(ESBLs) producing strains were 39.5% and 12.1%, respectively. Among the non-fermented sugar Gram-negative bacilli, the resistance rate of Pseudomonas aeruginosa to common antibiotics was lower than that of Acinetobacter baumannii, in which the detection rates of carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii were 9.8% and 65.8%, respectively. Haemophilus influenzae and Moraxella catarrhalis were more common in children, and the detection rates of β-lactamase-producing strains were 73.4% and 97.7%, respectively. Conclusion The clinical isolates were mainly Gram-negative bacteria. Haemophilus influenzae and Moraxella catarrhalis had a high rate of producing β-lactamases. At the same time, Acinetobacter baumannii had a high resistance rate to carbapenem antibiotics, and thus the management department of nosocomial infection should take corresponding measures to reduce its epidemic outbreak.