2020年蚌埠医学院第一附属医院细菌耐药性监测

摘要：目的 通过对2020年蚌埠医学院第一附属医院临床分离菌分布及对抗菌药物的耐药性分析，为临床合理选择抗菌药物提供参考。方法 采用自动化仪器法、纸片扩散法(K-B法)或E-test方法对我院2020年临床分离的菌株进行药敏试验，按CLSI 2020版标准判断结果，WHONET5.6软件统计分析数据。结果 2020年我院临床共分离4209株细菌，其中革兰阳性菌1121株(26.6%，1121/4209)，革兰阴性菌3088株(73.4%，3088/4209)株，前10位分离菌分别为：大肠埃希菌1093株(26.0%)、肺炎克雷伯菌565株(13.4%)、凝固酶阴性葡萄球菌402株(9.6%)、鲍曼不动杆菌354株(8.4%)、铜绿假单胞菌345株(8.2%)、金黄色葡萄球菌313株(7.4%)、奇异变形杆菌132株(3.1%)、屎肠球菌122株(2.9%)、粪肠球菌94株(2.2%)和阴沟肠杆菌63株(1.5%)。金黄色葡萄球菌和凝固酶阴性葡萄球菌中耐甲氧西林菌株的检出率分别为43.1%和66.2%，未检出耐万古霉素和利奈唑胺菌株。肠球菌属细菌中以屎肠球菌和粪肠球菌为主，屎肠球菌对大多数测试抗菌药物的耐药率高于粪肠球菌，检出少数耐万古霉素和利奈唑胺药的肠球菌。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)菌株占各自菌的63.1%和31.2%，肺炎克雷伯菌亚胺培南和厄他培南耐药率分别为26.7%和26.4%，较我院2017年有所下降(P<0.01)，其余肠杆菌目细菌对碳青霉烯类抗生素耐药率均小于10%。铜绿假单胞菌对亚胺培南耐药率为34.2%，对头孢吡肟、哌拉西林/他唑巴坦、氨曲南、左氧氟沙星和阿米卡星的耐药率均小于30%。鲍曼不动杆菌对阿米卡星的耐药率为31.0%，亚胺培南耐药率为89.5%。流感嗜血杆菌产β-内酰酶检出率为60.7%。结论 临床分离菌对常见抗菌药物耐药情况较严重，耐碳青霉烯类肺炎克雷伯菌的检出率有所下降，但仍值得警惕，应重视细菌耐药监测，继续加强医院感染的防控，合理使用抗菌药物。

Surveillance of antimicrobial resistance in the First Affiliated Hospital of Bengbu Medical College in 2020

Abstract Objective To investigate the distribution and antibiotic resistance of clinical isolates in the First Affiliated Hospital of Bengbu Medical College in 2020, and provide references for clinical antimicrobial choice. Methods Automated analytic systems, the Kirby-Bauer method, or the E-test method were employed to determine antimicrobial resistance of the clinically isolated strains in our hospital in 2020, the results were interpreted according to CLSL 2020 breakpoints and the data were analyzed by WHONET 5.6 software. Results A total of 4209 strains of bacteria were isolated in 2020, of which Gram-positive bacteria and Gram-negative organisms accounted for 26.6% and 73.4% respectively. The top ten isolates were: Escherichia coli (26.0%), Klebsiella pneumoniae(13.4%), coagulase-negative Staphylococcus (9.6%), Acinetobacter baumannii (8.4%), Pseudomonas aeruginosa (8.2%), Staphylococcus aureus (7.4%), Proteus mirabilis (3.1%), E. faecium (2.9%), E. faecalis (2.2%), and E. cloacae (1.5%). The prevalence of methicillin-resistant S. aureus and methicillin-resistant coagulase-negative Staphylococcus were 43.1% and 66.2%, respectively. No strains were found resistant to linezolid and vancomycin. E. faecium and E. faecalis were the major isolates in Enterococcus. The resistance rate of E. faecium to most of the tested antibacterial drugs was higher than that of E. faecalis. A few Enterococcus spp. resistant to vancomycin and linezolid were found. E. coli and K. pneumoniae strains producing extended-spectrum β-lactamases (ESBLs) accounted for 63.1% and 31.2% of their respective strains. The resistance rates of K. pneumoniae to imipenem and ertapenem were 26.7% and 26.4%, respectively, which were lower than those of our hospital in 2017 (P<0.01). The resistance rate of other Enterobacteriaceae bacteria to carbapenem antibiotics was less than 10%. The resistance rate of P. aeruginosa to imipenem was 34.2%, and the resistance rates to cefepime, piperacillin-tazobactam, aztreonam, levofloxacin, and amikacin were all less than 30%. The resistance rate of A. baumannii to amikacin was 31.0%, and the resistance rate to imipenem was 89.5%. The isolates producing β-lactamase accounted for 60.7% in H. influenza. Conclusion Drug resistance was serious in our hospital in 2020. The detection rate of carbapenem-resistant K. pneumoniae decreased. However, it still needs to be vigilant. Therefore, more attention should be paid to the rational use of antibiotics and antibiotic resistance surveillance, and hospital infection control should be