四川省自贡市第一人民医院2018—2020年细菌耐药性监测

目的 了解2018—2020年自贡市第一人民医院临床分离菌的分布以及对抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法 收集2018—2020年门诊和住院患者培养标本分离的菌株,采用纸片扩散法或自动化仪器检测法进行药敏试验,利用 WHONET5. 6软件对细菌耐药监测数据进行统计分析。结果 3年共分离12 658株细菌,其中革兰阳性菌3 630株,占28.7%;革兰阴性菌9 028株,占71.3%。居前五位的细菌分别是大肠埃希菌（28.9%）、肺炎克雷伯菌（10.2%）、金黄色葡萄球菌（9.5%）、铜绿假单胞菌（7.7%）、肺炎链球菌（5.3%）。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株检出率分别为20.7%和72.4%,未发现万古霉素和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数抗菌药物的耐药率均低于屎肠球菌。流感嗜血杆菌对氨苄西林的耐药率较高,约为70.0%。非脑脊液肺炎链球菌分离株对青霉素敏感率很高。肠杆菌目细菌对碳青霉烯类抗生素高度敏感,耐药率均低于3%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率均较低,小于8.0%和5.0%。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率较高,分别约为64.0%和60.0%。结论 临床分离菌株对常见抗菌药物的耐药性大多呈逐年上升趋势,应继续加强抗菌药物合理应用的管理及医院感染防控,做好耐药监测工作。

Surveillance of bacterial resistance in the First People's Hospital of Zigong City,Sichuan, 2018-2020

Objective To investigate the distribution of clinical isolates and antimicrobial resistance in Zigong First People's Hospital from 2018 to 2020, and we provide evidence for rational clinical use of antimicrobial agents. Methods The isolates from the culture specimens of outpatients and inpatients were collected from 2018 to 2020, and drug sensitivity test was performed by standard paper diffusion method or automatization test method. The drug resistance detection number of the bacteria was analyzed by WHONET 5.6 software. Results A total of 12 658 strains of bacteria were isolated, among which 3 630 strains were Gram-positive bacteria, accounting for 28.7%, and 9 028 strains were Gram-negative bacteria, accounting for 71.3%. The top five bacteria were Escherichia coli (28.9%), Klebsiella pneumoniae (10.2%), Staphylococcus aureus (9.5%), Pseudomonas aeruginosa (7.7%) and Streptococcus pneumoniae (5.3%). The detection rates of methicillin-resistant strains in Staphylococcus aureus and coagulase-negative Staphylococcus were 20.7% and 72.4%, respectively. No vancomycin and linezolid resistant staphylococci were found. The drug resistance rate of Enterococcus faecalis to most antibiotics was significantly lower than that of Enterococcus faecium. The resistance rate of Haemophilus influenzae to ampicillin was 70.0%. Non-cerebrospinal fluid (CSF) Streptococcus pneumoniae isolates were highly sensitive to penicillin. Enterobacteriaceae bacteria were highly sensitive to carbapenems antibiotics with drug resistance rates lower than 3%. The drug resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were lower than 8.0% and 5.0%. The resistance rates of Acinetobacter baumannii to imipenem and meropenem were 64.0% and 60.0%, respectively. Conclusion The resistance of clinical isolates to common antibiotics was increasing year by year, so the management of rational application of antibiotics and prevention and control of nosocomial infection should be strengthened, and drug resistance monitoring should be done well.