2017年贵州省某综合型医院细菌耐药性监测及动态分析

目的 分析2017年贵州省某综合型医院细菌耐药情况，并提出抗菌药物使用的合理性建议，以促进临床合理、安全的用药。方法 采用纸片扩散法（KB法）对7697株临床分离菌株作药敏实验，以2017年CLSI标准判断药敏试验结果，采用WHONET 5.6 软件，进行统计分析，结合我院细菌耐药结果对我院抗菌药物应用的合理性做出评价。结果 2017年我院共分离出病原菌7697株，其中革兰阴性菌4047株（52.58%），革兰阳性菌为2706株（35.16%）。MRSA的检出率为36.46%，未发现耐万古霉素的菌株；肠球菌属中，屎肠球菌和粪肠球菌均出现对万古霉素和替考拉宁耐药的菌株。肠杆菌科中大肠埃希菌对亚胺培南的耐药率为0.53%，肺炎克雷伯菌对亚胺培南的耐药率为15.94%；非发酵菌中铜绿假单胞菌对亚胺培南耐药率为22.99%，鲍曼不动杆菌对亚胺培南耐药率为67.31%。结论 目前我院细菌耐药率不断攀升，长期进行细菌耐药监测有助于了解耐药情况，同时结合药物特点，为临床合理用药提供依据。

Monitoring and Dynamic Analysis of Bacterial Resistance in a General Hospital in Guizhou Province in 2017

Objective To analyze the bacterial resistance of a comprehensive hospital in Guizhou Province in 2017, and to propose rationality recommendations for the use of antibiotics to promote rational and safe clinical use. Methods A paper-diffusion method (KB method) was used to test the drug-sensing strains of 7697 clinical isolates. The results of drug susceptibility test were judged by 2017 CLSI standard. The results were analyzed by WHONET 5.6 software, combined with the bacterial resistance results of our hospital. The rationality of the application of antibacterial drugs in the hospital was evaluated. Results In 2017, 7697 strains of pathogens were isolated from our hospital, including 4047 (52.58%) Gram-negative bacteria and 2706 (35.16%) Gram-positive bacteria. The detection rate of MRSA was 36.46%, and no vancomycin-resistant strain was found. In Enterococcus, Enterococcus faecium and Enterococcus faecalis showed strains resistant to vancomycin and teicoplanin. The resistance rate of Escherichia coli to imipenem in Enterobacteriaceae was 0.53%, and the resistance rate of Klebsiella pneumoniae to imipenem was 15.94%; Pseudomonas aeruginosa in non-fermentative bacteria The resistance rate of imipenem was 22.99%, and the resistance rate of Acinetobacter baumannii to imipenem was 67.31%. Conclusion At present, the bacterial resistance rate in our hospital is constantly rising. Long-term monitoring of bacterial resistance can help to understand the drug resistance, and at the same time, combined with the characteristics of the drug, provide a basis for clinical rational drug use.