2014-2016年邯郸市中心医院细菌耐药性监测结果分析

目的 了解2014-2016年邯郸市中心医院临床所分离细菌对抗菌药物的耐药性。方法 收集2014年1月1日-2016年12月31日邯郸市中心医院临床所分离的细菌，只分析同一患者同一部位的第一株菌。采用Vitek2-Compact和珠海美华MA120进行鉴定，药敏试验方法采用MIC和KB法，并采用WHONET 5.6软件进行统计分析。结果 邯郸市中心医院2014-2016年分离的菌株分别为3237、4484和4778株，共12499株细菌，其中革兰阴性菌8780株，占70.2%，革兰阳性菌3719株占29.8%。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)的检出率分别为38.38%和65.07%。屎肠球菌对绝大多数所测抗菌药物的耐药率明显高于粪肠球菌，葡萄球菌属和肠球菌属中均未发现万古霉素、替考拉宁和利奈唑胺耐药的菌株。肺炎链球菌以非脑脊液来源为主，成人多于儿童，且儿童分离株对青霉素均敏感，成人分离株青霉素耐药率为1.2%。大肠埃希菌和肺炎克雷伯菌超广谱β-内酰胺酶(ESBL)的检出率分别为49.4%和28.3%，对碳青霉烯类药物耐药率分别为1.8%和4.4%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为20.3%和13.6%，鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为63.8%和63.7%。结论 3年间细菌耐药性发生了变化，医生应该依据药敏监测结果合理选择抗菌药物。

Surveillance of antimicrobial resistance in Handan Central Hospital from 2014 to 2016

Objective To investigate the drug resistance of bacteria isolated from Handan Central Hospital in the corresponding period from 2014 to 2016. Methods The pathogenic microorganisms were isolated from patients from January 2014 to December 2016 in Handan Central Hospital. Only the first strain of the same point on the same patient was collected, and identified by VITEK2-Compact and MA120 systems. The drug susceptibility test was performed by the methods of minimum inhibitory concentration and disc diffusion. The results were analyzed by the WHONET 5.6 software. Results A total of 12,499 strains of non-repetitive bacterial were isolated from 2014 to 2016, with 3237 strains in 2014, 4,484 strains in 2015, and 4,778 strains in 2016. 8,780 (70.2%) Gram-negative bacteria and 3,719 (29.8%) Gram-positive bacteria were isolated. The prevalence of MRSA was 38.38% in Staphylococcus aureus and MRCNS was 65.07% in coagulase negative Staphylococcus. The resistance rates of Enterococcus faecium to most of the antibiotics tested were much higher than those of Enterococcus faecalis. No Staphylococcus or Enterococcus isolates were found resistant to vancomycin, teicoplanin or linezolid. The Streptococcus pneumoniae were mainly isolated from non-meningitis strains. There were more Streptococcus pneumoniae isolates isolated from adults than children. All the Streptococcus pneumoniae isolated from children werepenicillin-susceptible. 1.2% penicillin-resistant Streptococcus pneumoniae were found in adults. The prevalence of extended-spectrum beta-lactamase (ESBLs) was 49.4% in Escherichia coli and 28.3% in Klebsiella pneumoniae, respectively. The percentage of the Escherichia coli and Klebsiella pneumoniae resistant to carbapenems was 1.8% and 4.4%. The percentage of the Acinetobacter baumannii and Pseudomonas aeruginosa resistant to carbapenems was 20.3% and 63.8%, respectively. Conclusion In the past three years, the antimicrobial resistance of the bacteria changed. The doctors should use antibiotics rationally according to the results of resistance