2016年齐齐哈尔市第一医院细菌耐药性分析

目的 了解2016年齐齐哈尔市第一医院临床分离菌对常见抗菌药物的敏感性和耐药性，为临床合理使用抗菌药物提供实验室依据。方法 采用自动化仪器对2016年1月1日-12月31日齐齐哈尔市第一医院临床分离菌进行药敏试验，采用美国临床实验室标准化研究协会(CLSI)2014年版标准判断药敏结果及WHONET 5.6软件进行数据分析。结果 2016年共收集非重复临床分离菌3,505株，其中革兰阴性菌2,450株，占69.9%；革兰阳性菌1,055株，占30.1%。取自下呼吸道标本所占比率最高57.3%，其次为尿液10.5%和血液10.3%。排在前5位的细菌依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌和鲍曼不动杆菌，分别占18.43%、15.92%、14.41%、13.92%和7.93%。耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus，MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococci，MRCNS)的检出率分别为27.4%和74.2%。未发现对万古霉素和利奈唑胺的葡萄球菌。肠球菌属细菌中粪肠球菌对所测试的抗菌药的耐药率显著低于屎肠球菌，未发现耐万古霉素和利奈唑胺的肠球菌。大肠埃希菌、克雷伯菌属细菌(肺炎克雷伯菌、产酸克雷伯菌)和奇异变形菌的ESBLs，检出率分别为43.3%、20.1%和18.4%。肠杆菌科细菌对碳青霉烯类抗生素高度敏感，但是仍有对少数碳青霉烯类耐药肠杆菌科细菌(carbapenem resistant Enterobacteriaceae，CRE)，以肺炎克雷伯菌居多。对碳青霉烯类抗生素耐药的铜绿假单胞菌和不动杆菌属检出率分别为17.5%和60.4%。肺炎链球菌对红霉素和克林霉素耐药率大于98%，青霉素耐药的肺炎链球菌(PRSP)占2.3%。结论 细菌耐药性仍对临床构成严重威胁，应重视细菌耐药性监测并加强抗菌药物的合理使用。

Analysis of antibiotic resistance in bacterial isolates from the First Hospital of Qiqihaer in 2016

Objective To investigate the susceptibility and resistance of clinical bacterial isolates in the First Hospital of Qiqihaer during 2016. Methods Antimicrobial susceptibility test was carried out for the clinical isolates according to a standard protocol using automate system from January 1st, 2016 to December 31st, 2016. The results were analyzed with WHONET 5.6 software according to the Clinical and Laboratory Standards Institute (CLSI) 2014 guidelines. Results A total of 3505 Nonduplicate clinical isolates were collected during 2016, of which Gram-negative rods and Gram-positive cocci accounted for 69.9% and 30.1%, respectively. The main source of the pathogens was respiratory specimens (57.3%), followed by urine (10.5%) and blood (10.3%). Escherichia coli (18.43%) was the most frequently isolated bacteria, followed by Klebsiella pneumoniae (15.92%), Staphylococcus aureus (14.41%), Pseudomonas aeruginosa (13.92%), and Acinetobacter baumannii (7.93%). About 27.4% of the Staphylococcusaureus isolates were identified as MRSA, 74.2% of the coagulase negative Staphyococcus isolates were identified as MRCNS. No staphylococcal strain was resistant to vancomycin or linezolid. The resistance rates of E. faecalis strains to most of the test drugs were much lower than those of E. faecium, no enterococcal strain was found resistant to vancomycin or linezolid. The prevalence of ESBLs was 43.3% in E. coli, 20.1% in Klebsiella spp. (Klebsiella pneumoniae, Klebsiella oxytoca) and 18.4% in Proteus mirabilis. Enterobacteriaceae isolates were still highly susceptible to carbapenems, and some carbapenem-resistant stains were found in various Enterobacteriaceae spp., especially in Klebsiella pneumoniae. The prevalence of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii was 17.5% and 60.4%. More than 98% of Streptococcus pneumoniae strains were resistant to erythromycin and clindamycin, and the prevalence of penicillin-resistant Streptococcus pneumonia (PRSP) strains was 2.3%. Conclusion The antibiotic resistance of clinical bacterial isolates is growing, and more attention should be paid to resistance surveillance and rational use of