2019年重庆某三甲教学医院细菌耐药性监测

目的 了解2019年重庆医科大学附属第一医院临床分离菌对抗菌药物的耐药性。方法 采用自动化仪器法、纸片扩散法和E试验法测定抗菌药物敏感性，根据美国临床和实验室标准化协会(CLSI)2019标准进行结果判读，使用WHONET 5.6软件对药敏数据进行统计分析。结果 6757株非重复临床分离菌中革兰阴性菌(4471)占66.2%，革兰阳性菌(2286)占33.8%。耐甲氧西林金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)的检出率分别为23.8%和69.9%，粪肠球菌对利奈唑的耐药率为7.6%，检出3株耐万古霉素的肠球菌(VRE)。产超广谱β-内酰胺酶(ESBL)的大肠埃希菌、肺炎克雷伯菌和奇异变形菌的检出率分别为54.8%、22.9%和29.9%，耐碳青霉烯的肠杆菌科细菌(CRE)、铜绿假单胞菌(CRPA)和鲍曼不动杆菌(CRAB)的检出率分别为6.7%(183/2726)、24.5%(145/593)、68.2%(305/447)，肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为12.8%和13.2%、18.2%和13.8%、66.1%和66.0%。流感嗜血菌β-内酰胺酶阳性率为53.4%。结论 临床分离菌仍以革兰阴性菌为主，CRE有增加的趋势，耐碳青霉烯的肺炎克雷伯菌(CRKP)增加尤为明显。

Surveillance of antimicrobial resistance in clinical isolatesin a tertiary teaching hospital in Chongqing, 2019

Objective To investigate the resistance profile of clinical bacterial isolates to commonly used antimicrobial agents in the First Affiliated Hospital of Chongqing Medical University during 2019. Methods Antimicrobial susceptibility was tested by automated systems the disk diffusion method, and the E-test method. Results were interpreted according to the breakpoints of CLSI 2019. The data were analyzed by WHONET 5.6 software. Results 6,757 unduplicated strains were isolated in 2019. Of them, 4,471 ones (66.2%) were identified to be Gram-negative and Gram-positive bacteria accounted for 33.8% in total. The detection rates of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCNS) were 23.8% and 69.9%, respectively. The resistance rate of E. faecalis to linezolid was 7.6%, three strains of vancomycin-resistant enterococcus(VRE) were detected. The rates of extended-spectrum β-lactamase (ESBL)-producing isolates in E. coli, K. pneumonia and P. mirabilis were 54.8% , 22.9% and 22.9%, respectively. The prevalence of carbapenem-resistant Enterobacteriaceae(CRE), P. aeruginosa(CRPA), and A. baumannii(CRAB) were 6.7%, 24.5% and 68.2% respectively. The resistance rate of K. pneumoniae, P. aeruginosae and A. baumannii to imipenem and meropenem were 12.8% and 13.2%, 18.2% and 13.8%, 66.1% and 66.0%, respectively. The isolates producing β-lactamase accounted for 53.4% in H. influenza. Conclusion The main clinical isolates in this setting was still Gram-negative bacteria and the increasing trend of CRE was witnessed, especially carbapenem-resistant K. pneumoniae (CRKP).