2017年安徽省某三甲医院细菌耐药性监测

目的了解铜陵市人民医院2017年临床分离细菌对抗菌药物的耐药状况。方法对2017年1—12月临床分离菌采用纸片扩散法(KB)进行药敏试验,按CLSI 2017年版标准判读药敏试验结果,采用WHONET 5.6软件进行数据分析。结果临床分离细菌共3436株,其中革兰阳性菌719株,占20.9%;革兰阴性菌2717株,占79.1%。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23.8%和72.3%,耐甲氧西林株对β-内酰胺类抗生素和其他测试抗菌药物的耐药率显著高于甲氧西林敏感株,未发现对万古霉素和替考拉宁耐药的葡萄球菌。粪肠球菌对青霉素、氨苄西林和呋喃妥因的耐药率较低,屎肠球菌对氯霉素的耐药率较低,5.3%屎肠球菌对万古霉素耐药。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形菌中ESBLs的检出率分别为41.4%、50.7%和19.4%。肠杆菌科细菌中克雷伯菌属和沙雷菌属对碳青霉烯类抗生素耐药率较高,分别为37.5%和36.0%,其他菌属的耐药率低于3%。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别80.3%和79.1%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为29.7%和28.4%。肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌中广泛耐药株的检出率分别为31.3%(171/546)、0.6%(3/508)和0.7%(3/416)。结论本院革兰阴性菌呈增多趋势,尤其广泛耐药的肺炎克雷伯菌应引起高度关注,做好细菌耐药性监测,加强临床抗菌药物的合理使用和医院感染控制。

Surveillance of bacterial resistance in one tertiary hospitals in Anhui during 2017

Objective To investigate the antimicrobial resistance of clinical isolates from Tongling People's Hospital during 2017. Methods The disc diffusion test (Kirby-Bauer method) was employed to study the antimicrobial resistance from January to December 2017. The data were analyzed using the WHONET 5.6 software according to CLSI 2017 breakpoints. Results A total of 3,436 clinical isolates were collected. Gram negative organisms and Gram positive organisms accounted for 79.1% and 20.9%, respectively. The prevalence of methicillin-resistant strains in S. aureus (MRSA) and coagulase negative Staphylococcus (MRCNS) were 23.8% and 72.3%, respectively. The resistance rates of MR strains to beta-lactams and other antimicrobial agents were much higher than those of MS strains. No staphylococcal strain was found resistant to vancomycin or teicoplanin. E. faecalis showed relatively lower resistance to penicillin, ampicillin, and nitrofurantoin. E. faecium showed relatively lower resistance to chloramphenicol. The prevalence of vancomycin-resistant was 5.3% in E. faecium. The prevalence of ESBLs-producing strains was 41.4% in E. coli, 50.7% in Klebsiella spp. (K. pneumoniae and K. oxytoca), and 19.4%in Proteus mirabilis. The prevalence of carbapenem-resistant was37.5% and 36.0% in Klebsiella spp. and Serratia spp., respectively, and was less than 3% in other Enterobacteriaceae. The percentage of A. baumannii strains resistant to imipenem and meropenem was 80.3% and 79.1%, respectively. In addition, 29.7% and 28.4% of P. aeruginosa strains were resistant to imipenem and meropenem. The prevalence of extensively-drug resistant(XDR) bacterium was 31.3% (171/546) in K. pneumoniae, 0.6%(3/508) in A. baumannii, and 0.7%(3/416) in P. aeruginosa. Conclusion There appears a trend of increasing Gram negative bacteria in this hospital, especially the extensive drug resistant K. pneumoniae, which is of great concern. It isnecessary to maintain good practicein surveillance of bacterial resistance and management of clinical use of antimicrobial agents, and strengthen hospital infection