2018年安庆市第一人民医院细菌耐药性监测

摘要：目的 了解安庆市第一人民医院2018年临床分离菌株对抗菌药物的耐药性及敏感性。方法 采用自动化仪器法或纸片扩散法进行药敏试验，药敏结果按2018年临床和实验室标准化协会(CLSI)标准判读，采用WHONET 5.6软件统计分析。结果 2018年共检出962株细菌，其中革兰阳性菌占22.7%(218/962)；革兰阴性菌占77.3%(744/962)。革兰阴性菌如大肠埃希菌占24.9%，分离率最高；然后是肺炎克雷伯菌、铜绿假单胞菌，菌株主要分离于呼吸道和分泌物标本，分别占38.6%和22.6%。对革兰阳性菌如耐甲氧西林金黄色葡萄球菌(MRSA)及耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率各占29.4%和91.3%，尚未检出耐利奈唑胺和万古霉素的葡萄球菌。肠球菌属里的粪肠球菌和屎肠球菌各占29.8%和70.2%，目前还没有分离出对万古霉素产生耐药的肠球菌。产ESBL的大肠埃希菌、克雷伯菌属和奇异变形菌检出率各占其菌种的56.8%、44.2%和5.3%。肠杆菌科细菌对碳青霉烯类抗菌药物仍然保持高敏感性，其中肺炎克雷伯菌、肠杆菌属细菌对亚胺培南等碳青霉烯类的耐药率均≤4.8%；铜绿假单胞菌对亚胺培南等碳青霉烯类的耐药率较高，为20.9%，但对左氧氟沙星、环丙沙星、哌拉西林/三唑巴坦、妥布霉素、头孢吡肟、头孢他啶、庆大霉素和阿米卡星的耐药率均<25%；鲍曼不动杆菌对亚胺培南等碳青霉烯类抗生素的耐药率为78.9%，对除阿米卡星、米诺环素以外的抗菌药物的耐药率均>65%。结论 该院主要临床分离细菌对常用抗菌药物呈现不同程度耐药，应加强医院感控措施，细菌室专业人员应做好细菌耐药监测工作，加强与临床医师的沟通，指导临床合理使用抗菌药物，采取有效措施防治耐药菌株的广泛传播。

Surveillance of antimicrobial resistance in the First People’s Hospital of Anqing in 2018

Abstract Objective To investigate the antibiotic resistance of clinical isolates in the First People’s Hospitalof Anqing in 2018. Methods The antimicrobial susceptibility testing was carried out according to a unified protocolusing automated systems or the Kirby-Bauer method. Results were interpreted according to CLSI 2018 breakpointsand analyzed by WHONET 5.6 software. Results A total of 962 bacterial isolates were collected in 2018. Therewere 218 strains (22.7%) of Gram-positive bacteria and 744 strains (77.3%) of Gram-negative bacteria. The mostfrequently isolated bacteria were Escherichia coli (24.9%), followed by Klebsiella pneumoniae, and Pseudomonasaeruginosa. The strains were mainly isolated from the respiratory tract (38.6%) and secretion (22.6%). The prevalenceof methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus (MRSAand MRCNS) was 29.4% and 91.3%, respectively. No Staphylococcus strains were found resistant to linezolid orvancomycin. Enterococcus faecalis and Enterococcus faecium accounted for 29.8% and 70.2% of total Enterococcusisolates. No Enterococcus strains were found resistant to vancomycin. The prevalence of ESBLs-producing strains was56.8% in E. coli, 44.2% in Klebsiella spp., and 5.3% in Proteus mirabilis. Enterobacteriaceae strains were still highlysusceptible to carbapenems. The resistance rates of Klebsiella pneumoniae and Enterobacteriaceae to imipenem werelower than 4.8%. The resistance rate of P. aeruginosa to imipenem was 20.9%, but lower than 25% to levofloxacin,ciprofloxacin, piperacillin-tazobactam, tobramycin, cefepime, ceftazidime, gentamycin, and amikacin. The resistancerate of Acinetobacter baumannii to imipenem was 78.9%, and the resistance rates to all the antibiotics tested exceptamikacin and minocycline were higher than 65%. Conclusion The clinical bacterial isolates show various levels ofresistance to antibacterial agents. More attention should be paid to infection control measures. The communicationbetween laboratorians and clinicians should be further improved in addition to rational use of antimicrobial agents andthe spread of resistant strains should be prevented.