2013-2019年无菌体液病原菌分布及耐药性分析

目的 了解本院2013年3月至2019年3月临床分离的脑脊液及其他无菌体液病原菌的分布及耐药情况。方法 收集和统计2013年3至2019年3月脑脊液及其他无菌体液标本分离的病原菌分布及耐药性特点,运用WHONET5.6软件进行菌株分布及药敏结果分析。结果 共分离病原菌1 450株,革兰阳性菌806株(55.6%);革兰阴性菌556株(38.3%);真菌88株(6.1%)。常见病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、粪肠球菌。无菌体液标本中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)检出率分别为35.8%和75.4%,未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。肠球菌属中屎肠球菌对除四环素外的大多数抗菌药物耐药率明显高于粪肠球菌。产超广谱内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为60.6%和65.9%,除肺炎克雷伯菌对亚胺培南耐药率大于10.0%,其他肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感。多重耐药鲍曼不动杆菌和铜绿假单胞菌检出率分别为65.3%和12.7%。结论 应加强常见耐药菌的监测,尤其是耐碳青霉烯类肠杆菌科细菌和多重耐药鲍曼不动杆菌应引起高度关注,根据药敏试验结果合理使用抗菌药物,加强耐药菌感染控制,以减少耐药菌株产生。

Distribution and drug resistance of pathogenic bacteria from aseptic body fluid from 2013 to 2019

Objective To investigate the susceptibility and resistance of pathogenic bacteria isolated from cerebrospinal fluid and other sterile body fluids in the hospital from March 2013 to March 2019.Methods The distribution and drug resistance of pathogens isolated were collected and counted from March 2013 to March 2019,and the WHONET5.6 software was used to perform statistical analysis on drug susceptibility results.Results A total of 1450 strains of pathogenic bacteria from cerebrospinal fluid and other sterile body fluids were isolated in the survey period which included 806 Gram-positive strains(55.6%),556 Gram-negative strains(38.3%)and 88 fungi strains(6.1%).Coagulase negative staphylococcus(CNS),Escherichia coli,Acinetobacter baumannii,Klebsiella pneumoniae and Enterococcus faecalis were the most common pathogens from sterile body fluids.Generally,35.8%of the S.aureus isolates and 75.4%of the CNS isolates from sterile body fluids were resistant to methicillin.Staphylococcus resistant to vancomycin,teicoplanin and linezolid were not found.The resistance rate of Enterococcus faecium strains showed much more resistance rates to most antibiotics(except tetracycline)than Enterococcus faecalis.The detection rates of ESBLs producing Escherichia coli and Klebsiella pneumoniae were 60.6%and 65.9%,respectively.Enterobacteriaceae strains were still highly susceptible to carbapenems,except for Klebsiella pneumoniae,which was more than 10.0%resistant to imipenem.Multidrug-resistant strains were identified in the Acinetobacter baumannii(65.3%)and Pseudomonas aeruginosa(12.7%)strains isolated from sterile body fluid.Conclusion The surveillance of common drug-resistant bacteria should be strengthened,especially carbapenem-resistant Enterobacteriaceae and multi-drug-resistant Acinetobacter baumannii should be highly concerned.According to the results of drug susceptibility test,antibiotics should be rationally used and infection control of drug-resistant bacteria should be strengthened so as to reduce the production of drug-resistant bacteria.