2016—2018年河南某医院临床分离菌分布及耐药性分析

目的 了解河南省胸科医院2016—2018年临床常见标本细菌分布及对常用抗菌药物的敏感性和耐药性，为合理使用抗菌药物提供依据。方法 收集该院2016年1月—2018年12月临床分离细菌，采用全自动细菌鉴定药敏仪或纸片扩散法进行抗菌药物的敏感性试验，按照2018年CLSI M100标准判断结果，数据统计分析采用WHONET 5.6软件。结果 3年间共检出临床分离菌4421株，其中革兰阳性细菌702株(15.9%)，革兰阴性菌3719株(84.1%)。金黄色葡萄球菌和凝固酶阴性葡萄球菌耐甲氧西林株(MRSA和MRCNS)平均检出率分别为59.1%和85.9%，葡萄球菌属中尚未检出对万古霉素、替考拉宁耐药的菌株。粪肠球菌对多数抗菌药物的耐药性低于屎肠球菌，未发现对万古霉素的耐药的粪肠球菌，但是发现1株耐万古霉素的屎肠球菌。3年间检出耐碳青霉烯类肠杆菌科细菌平均检出率为16.5%(281/1703)；碳青霉烯耐药的肺炎克雷伯菌和大肠埃希菌平均检出率分别为24.9%(221/889)和2.2%(4/181)；耐碳青霉烯类铜绿假单胞菌平均检出率为15.7%(110/700)；耐碳青霉烯类鲍曼不动杆菌平均检出率为57.1%(237/415)。ICU分离出的肠杆菌科细菌和非发酵细菌的耐药率普遍高于非ICU分离细菌。结论

Distribution and drug resistance analysis of clinical isolates in a hospital in Henan province from 2016 to 2018#br#

Objective To investigate the distribution and antimicrobial resistance of common clinical isolates in Henan chest hospital from 2016 to 2018, and provide evidence for the rational use of antibiotics. Methods Clinical isolates of bacteria were collected in this hospital from January 2016 to December 2018. Susceptibility test was carried out using the Kirby-Bauer method or automated systems. Results were analyzed according to CLSI 2018 breakpoints. Results A total of 4,421 clinical isolates were detected in the past three years, including 702 (15.9%) Gram-positive and 3,719 (84.1%) Gram-negative bacteria. The prevalence of methicillin-resistant strains was 59.1% in S. aureus (MRSA) and 85.9% in coagulase negative Staphylococcus (MRCNS) on average. No staphylococcal strains were found resistant to vancomycin and teicoplanin. The resistance of Enterococcus faecalis to most antibiotics was lower than that of Enterococcus faecalis. No vancomycin resistant Enterococcus faecalis was found, but one strain of Enterococcus faecalis was found to be vancomycin resistant. The average detection rate of carbapenem-resistant Enterobacteriaceae in three years was 16.5% (281/1703). The average detection rates of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli respectively were 24.9% (221/889) and 2.2% (4/181). The average detection rate of carbapenem-resistant Pseudomonas aeruginosa was 15.7% (110/700). The average detection rate of carbapene-resistant Acinetobacter baumannii was 57.1% (237/415). The drug resistance rates of Enterobacteriaceae and non-fermented bacteria isolated in ICU were generally higher than those isolated in Non-ICU. Conclusion The detection rate of carbapenem-resistant Klebsiella pneumoniae in this hospital was high, and the situation of bacterial resistance was very serious, and therefore the rational use of antimicrobial agents and measures of infection control should be strengthened, and the monitoring of bacterial resistance should be done