中南大学湘雅医院2013—2017年细菌耐药性监测

 目的 了解中南大学湘雅医院2013—2017年临床分离细菌的分布以及对常用抗菌药物的敏感性，为临床合理使用抗菌药物提供依据。方法 收集门诊和住院患者培养标本分离的菌株，采用标准纸片扩散法或自动化仪器检测法进行药敏试验，对细菌耐药监测数据进行统计分析。结果 共分离38 075株细菌，其中革兰阳性菌13 184株，占34.6%，革兰阴性菌24 891株，占65.4%。居前五位的细菌分别是大肠埃希菌（5 158株，13.5%）、不动杆菌属（4 740株，12.4%）、克雷伯菌属（4 470株，11.7%）、凝固酶阴性葡萄球菌（4 008株，10.5%）、铜绿假单胞菌（3 577株，9.4%）。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31.7%（980/3 096）和77.7%（3 113/4 008），MRSA的检出率呈下降趋势（P<0.01）；葡萄球菌对绝大多数抗菌药物的耐药率耐甲氧西林株高于甲氧西林敏感株；未检测出耐万古霉素的葡萄球菌属细菌以及耐利奈唑胺的金黄色葡萄球菌。屎肠球菌对青霉素、氨苄西林、高浓度庆大霉素、高浓度链霉素、红霉素、呋喃妥因、氟喹诺酮类抗菌药物的耐药率高于粪肠球菌（均P<0.01），粪肠球菌和屎肠球菌对万古霉素和利奈唑胺的耐药率<3.5%。未检测出耐利奈唑胺和万古霉素的链球菌属细菌。大肠埃希菌、肺炎克雷伯菌对碳青霉烯类抗生素的耐药率分别为0.6%~3.9%、6.3%~24.9%。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南的耐药率分别为29.5%~34.7%、69.9%~85.7%。大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌对碳青霉烯类抗生素的耐药率呈逐年上升趋势（均P<0.01）。结论 鲍曼不动杆菌对碳青霉烯类抗生素的耐药率较高，肺炎克雷伯菌对碳青霉烯类抗生素的耐药率迅速上升。应加强抗菌药物的合理使用，采取有效的医院感染控制措施，减少耐药菌的产生及传播。

Surveillance of antimicrobial resistance in clinical isolates from Xiangya Hospital of Central South University in 2013-2017

Objective To investigation the distribution and antimicrobial resistance of clinical bacterial strains from Xiangya Hospital of Central South University in 2013-2017, and provide basis for clinical rational use of antimicrobial agents. Methods Strains isolated from cultured specimens of outpatients and inpatients were collected, antimicrobial susceptibility testing was performed by Kirby-Bauer method or automated system, bacterial resistance monitoring data were analyzed statistically. Results A total of 38 075 bacterial strains were isolated, including 13 184 (34.6%) strains of gram-positive bacteria and 24 891 (65.4%) strains of gram-negative bacteria. The top five isolated bacteria were Escherichia coli(n=5 158,13.5%),Acinetobacter spp.(n=4 740,12.4%), Klebsiella spp. (n=4 470,11.7%), coagulase-negative staphylococcus (n=4 008,10.5%), and Pseudomonas aeruginosa(n=3 577, 9.4%). Isolation rates of methicillin-resistant Staphylococcus aureus(MRSA) and methicillin-resistant coagu- lase-negative staphylococcus (MRCNS) were 31.7% (980/3 096) and 77.7% (3 113/4 008) respectively, isolation rate of MRSA showed a decreasing tendency(P<0.01); resistance rate of methicillin-resistant strains of Staphylococcus was higher than methicillin-sensitive strains; vancomycin-resistant Staphylococcus and linezolid-resistant Staphylococcus aureus were not found. Resistance rates of Enterococcus faecium to penicillin, ampicillin, high concentration gentamycin, high concentration streptomycin, erythromycin, nitrofurantoin and fluoroquinolones were all much higher than those of Enterococcus faecalis (all P<0.01), resistance rate of Enterococcus faecalis and Enterococcus faecium to vancomycin and linezolid was<3.5%. Linezolid- or vancomycin-resistant Streptococcus spp. was not found. Resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems were 0.6%-3.9% and 6.3%-24.9% respectively. Resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem were 29.5%-34.7% and 69.9%-85.7% respectively. Resistance rates of Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii to carbapenems increased year by year (all P<0.01). Conclusion Resistance rate of Acinetobacter baumannii to carbapenems is high, resistance rate of Klebsiella pneumoniae to carbapenems is rising rapidly. It is necessary to strengthen the rational use of antimicrobial agents, take effective measures to control healthcare-associated infection, and reduce the emergence and spread of antimicrobial-resistant bacteria.