某教学医院2015—2018年神经外科病房细菌耐药性监测

目的 了解神经外科病房临床分离菌的耐药性变迁，为临床合理用药提供依据。方法 收集2015—2018年间我院神经外科住院患者送检标本的细菌培养及体外药敏试验结果，使用WHONET 5.6软件对药敏数据进行统计分析。结果 2015—2018年共分离非重复临床分离菌2123株，其中革兰阴性菌1563株(73.6%)、革兰阳性菌560株(26.4%)；标本类型以痰液(62.6%)、尿液(12.8%)、脑脊液(8.9%)和血液(8.6%)为主；分离居前5位的细菌是鲍曼不动杆菌(20.3%)、肺炎克雷伯菌(16.4%)、铜绿假单胞菌(14.5%)、大肠埃希菌(8.9%)和金黄色葡萄球菌(7.7%)；鲍曼不动杆菌对亚胺培南和美罗培南的耐药率均>65%，铜绿假单胞菌对碳青霉烯类药物的耐药率在30%左右，肺炎克雷伯菌2015—2016年对碳青霉烯类的药物耐药率均<30%，2017年对碳青霉烯类药物耐药性明显升高(亚胺培南41.3%、美罗培南41.9%)，2018年对碳青霉烯类药物的耐药性有较大幅度的下降(亚胺培南3.4%、美罗培南3.4%)，大肠埃希菌对碳青霉烯类的药物耐药率仍较低(<3%)，金黄色葡萄球菌对苯唑西林的耐药率由57.9%降至15.8%，未发现对利奈唑胺和万古霉素耐药的金黄色葡萄球菌。凝固酶阴性的葡萄球菌(CNS)是血液和脑脊液标本中分离居首位的细菌，二者耐甲氧西林的凝固酶阴性的葡萄球菌(MRCNS)的检出率均>80%，在脑脊液中还分离到2株对利奈唑胺耐药的科氏葡萄球菌。结论 神经外科病房临床分离菌以鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌为主，近年来肺炎克雷伯菌的分离率有明显增高的趋势，非发酵菌和肠杆菌科细菌对碳青霉烯类药物的耐药率也呈上升的趋势，耐甲氧西林的金黄色葡萄球菌的检出率呈逐年下降的趋势，加强医院内感染防控措施及细菌耐药监测，合理使用抗菌药物。

Antimicrobial resistance surveillance of clinical isolates in neurosurgical#br#wards of a teaching hospital from 2015 to 2018

Objective To understand the change of antimicrobial resistance of clinical isolates in neurosurgical wards, and to provide basis for clinical rational antimicrobial use. Methods The results of bacterial cultures and drug sensitivity tests in vitro were collected from neurosurgical inpatients in our hospital from 2015 to 2018. The sensitivity data were statistically analyzed using software WHONET 5.6. Results From 2015 to 2018, a total of 2,123 non-repeating clinical isolates were isolated, including 1,563 Gram-negative (73.6%) and 560 Gram-positive (26.4%) strains. The specimens were mainly sputum (62.6%), urine (12.8%), cerebrospinal fluid (8.9%), and blood(8.6%). The top five isolated bacteria were Acinetobacter baumannii (20.3%), Klebsiella pneumoniae (16.4%), Pseudomonas aeruginosa (14.5%), Escherichia coli (8.9%), and Staphylococcus aureus (7.7%), respectively. The resistance rates of Acinetobacter baumannii to imipenem and meropenem both exceeded 65%. The resistance rate of Pseudomonas aeruginosa to carbapenems kept around 30%. For Klebsiella pneumoniae, the resistance rate to carbapenems stayed less than 30% between 2015 and 2016, which significantly increased in 2017 (41.3% for imipenem and 41.9% for meropenem), followed by drastically decline in 2018 (3.4% for imipenem and 3.4% for meropenem). Escherichia coli still showed relative low resistance rate to carbapenems (<3%). The resistance rate of Staphylococcus aureus to oxacillin decreased from 57.9% to 15.8%. No Staphylococcus aureus resistant to linezolid or vancomycin was found. Coagulase-negative Staphylococcus (CNS) was the first bacteria isolated from blood and cerebrospinal fluid samples. The detection rate of MRCNS was over 80%. Two strains of linezolid-resistant Staphylococcus were isolated from cerebrospinal fluid. Conclusion Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the main clinical isolates in neurosurgical wards. In recent years, the isolation rate of Klebsiella pneumoniae has increased significantly, so does the resistance rate of non-fermentative bacteria and Enterobacteriaceae to carbapenems. The detection rate of methicillin-resistant Staphylococcus aureus has decreased year by year. The prevention and control measures of nosocomial infections, the antimicrobial resistance surveillance, and the rational use of antimicrobial drugs should be strengthened.