2015—2019年杭州市中医院细菌耐药性监测

摘要：目的 了解杭州市中医院2015—2019年临床分离菌的构成变化和对常用抗菌药物的耐药变迁，为临床合理应用抗菌药物提供有力的数据支持。方法 对杭州市中医院5年间临床分离菌做回顾性分析，采用KB法及自动化仪器法按统一方案进行抗菌药物敏感性试验。按 CLSI 2019版判断结果，采用WHONET5.6软件进行分析。结果 2015年1月—2019年12月临床分离菌株共30,634株，革兰阳性菌占29.6%(9,067/30,634)，革兰阴性菌占67.9%(20,789/30,634)。5年间分离的病原菌排名前10位的细菌分别是大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、奇异变形菌、屎肠球菌、粪肠球菌、嗜麦芽寡养单胞菌和无乳链球菌。金黄色葡萄球菌中耐甲氧西林株的平均检出率由2015年的59.9%下降至2019年的46.2%，未发现万古霉素和替考拉宁耐药菌株。肠杆菌科细菌对碳青霉烯类仍较为敏感，但是，肺炎克雷伯菌对亚胺培南和美罗培南的耐药率较高。大肠埃希菌对美罗培南和亚胺培南的耐药率在2015年到2019年间，从2015年的10.2%和2.2%，逐渐上升后又逐渐回落至2019年的4.2%和6.2%。肺炎克雷伯菌对美罗培南和亚胺培南的耐药率从2015年的14.7%和5.3%，分别上升至2019年的19.5%和24.2%。 在非发酵菌中，包括铜绿假单胞菌和不动杆菌属对亚胺培南和美罗培南的耐药率均呈下降趋势。结论 本院5年的耐药监测显示，我院临床分离菌对常用抗菌药物的耐药率普遍较高，耐甲氧西林金黄色葡萄球菌和耐碳青霉烯类肺炎克雷伯菌的检出率仍较高。应进一步加强院感防控措施和抗菌药物临床应用管理措施，持续做好细菌耐药性监测工作，指导临床合理使用抗菌药物。

Surveillance report of antimicrobial resistance in the clinical isolates from Hangzhou Hospital of Traditional Chinese Medicine in 2015—2019

Abstract Objective To report the distribution and antibiotic resistance of bacterial strains isolated in theHangzhou Hospital of Traditional Chinese Medicine during 2015—2019 for improving clinical treatment of bacterialinfections. Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using theKirby-Bauer method or automated systems. The results were interpreted according to the clinical and laboratorystandards institute (CLSI) 2019 breakpoints, and analyzed using WHONET 5.6. Results A total of 30,634 clinicalisolates were collected during 2015—2019, of which Gram positive organisms accounted for 29.6%(9,067/30,634) andgram negative organisms 67.9%(20,789/30,634). The prevalence of methicillin-resistant strains was 59.9% in 2015and down to 46.2% in 2019 in Staphylococcus aureus. No staphylococcal strain was found resistant to vancomycin andteicoplanin. Most Enterobacteriaceae isolates were still sensitive to carbapenems. Except for Klebsiella pneumoniae,the resistant rates were 14.7% and 5.3% to imipenem and meropenem respectively in 2015, and up to 19.5% and24.2% in 2019 respectively. While the resistant rates to imipenem and meropenem were declining in Acinetobacter.strains and Pseudomonas aeruginosa strains respectively during the five years from 2015 to 2019. ConclusionsAntimicrobial resistance increased in the clinical isolates especially in MRSA and CRKP in this hospital during thefive years from 2015 to 2019. We should continue to strengthen hospital infection control and management of clinicaluse of antimicrobial agents.