某三级结核病专科医院多重耐药菌分布及耐药性

目的分析安徽省胸科医院（结核病专科医院）2016年临床分离多重耐药菌的分布及对常见抗菌药物的耐药状况。 方法对安徽省胸科医院2016年1至12月期间送检标本中分离出的165株多重耐药菌进行回顾性分析，分析分离菌株的构成、多重耐药菌标本来源构成、年龄段和患者来源构成以及药敏结果。 结果多重耐药菌主要以产超广谱β内酰胺酶（ESBLs）大肠埃希菌、ESBLs肺炎克雷伯菌、耐碳青霉烯类抗菌药物鲍曼不动杆菌（CR-AB）、耐甲氧西林金黄色葡萄球菌（MRSA）、耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）、多重耐药铜绿假单胞菌（MDRPA）组成，其分离标本主要来自痰液、灌洗液、中段尿。CR-AB对氨基糖苷类药物阿米卡星耐药率最低为57.0%，ESBLs大肠埃希菌对碳青霉烯类药物亚胺培南和美罗培南耐药率最低均为0%，ESBLs肺炎克雷伯菌对碳青霉烯类药物亚胺培南和美罗培南的敏感率均达到86.8%。MDRPA对氨基糖苷类药物阿米卡星和庆大霉素耐药率低，分别为11.6%和17.3%，MRSA、MRCNS对万古霉素和利奈唑胺敏感率均为100%。 结论虽然多重耐药菌对大部分药物产生高的耐药性，但亚胺培南、美罗培南在ESBLs肺炎克雷伯菌和ESBLs大肠埃希菌的治疗中还是具有很好的抗菌活性，但还是已经检出耐碳青酶烯酶类肠杆菌科菌株；而阿米卡星和庆大霉素在CR-AB和MDRPA的治疗中还具有比较好的抗菌活性，万古霉素和利奈唑胺对MRSA、MRCNS的抗菌活性均最强。

Distribution and antibiotic resistance of multidrug-resistant bacteria in a tertiary tuberculosis hospital

ObjectiveTo analyze the distribution and antibiotic resistance of multidrug-resistant organisms (MDROS) isolated in Anhui Chest Hospital in 2016. MethodsA retrospective analysis was performed of the distribution and drug sensitivity of 165 clinical isolates of MDROS in Anhui Chest Hospital in 2016. ResultsMDROS mainly included extended-spectrum beta-lactamase (ESBL) producing Escherichia coli, ESBL producing Klebsiella pneumoniae, carbopenem resistant Acinetobacter baumannii (CR-AB), methicillin resistant Staphylococcus aureus (MRSA), methicillin resistant coagulase negative staphylococci (MRCNS), and multidrug resistant/pandrug resistant Pseudomonas aeruginosa (MDRPA). Specimens from which MDROS were isolated mainly included sputum, lavage fluid, and urine. Multidrug resistant Acinetobacter baumannii had the lowest resistance rate to amikacin (57%). ESBL producing Escherichia coli had the lowest resistance rates to imipenem and meropenem (0% for both). The sensitivity rates of ESBLs producing Klebsiella pneumoniae to imipenem and meropenem were both 86.8%. MDRPA had the lowest resistance rates to gentamicin and amikacin (11.6% and 17.3%, respectively). The sensitivity rates of MRSA and MRCNS to vancomycin and linezolid were both 100%. ConclusionsThe drug resistance of multidrug resistant bacteria is serious. Imipenem or meropenem has good antibacterial activity against ESBL producing Klebsiella pneumoniae and Escherichia coli, although carbapenem resistant Enterobacteriaceae strains have been detected. Amikacin and gentamicin have good antibacterial activity against CR-AB and MDRPA. Vancomycin and linezolid have the strongest antibacterial activity against MRSA and MRCNS.