2013-2014年南阳市市区五家三级综合医院细菌耐药监测评价

目的:监测评价2013-2014年南阳市市区五家三级综合医院检出菌分布和耐药情况。方法:收集五家医院临床分离菌信息,对细菌培养阳性率、常见分离菌种类、细菌药敏结果等进行统计分析。结果:五家医院两年共送检标本102 318例,其中检出28 755例,检出阳性率为28.10%。分离的28 755株细菌中革兰阳性菌5 755株(占20.01%),革兰阴性菌20 689株(占71.95%),真菌2 311株(占8.04%)。主要检出菌为大肠埃希菌(占14.82%)、肺炎克雷伯菌(占13.75%)、铜绿假单胞菌(占12.41%)、鲍曼不动杆菌(占10.01%)、凝固酶阴性葡萄球菌(占8.04%)、金黄色葡萄球菌(占5.16%)等。MRSA及MRCNS的检出率分别为56.81%和76.95%,大肠杆菌属和肺炎克雷伯菌属产超广谱β-内酰胺酶菌的检出率分别为59.99%和38.71%,未检出对万古霉素耐药的葡萄球菌。葡萄球菌对青霉素、头孢呋辛、红霉素耐药率在80%以上,对庆大霉素、呋喃妥因较敏感,耐药率在4.68%~31.32%之间。大肠埃希菌和肺炎克雷伯菌对氨苄西林、头孢唑林、头孢呋辛、头孢曲松耐药率在63.87%~93.03%之间,对亚胺培南、美罗培南、呋喃妥因、阿米卡星、哌拉西林他唑巴坦和头孢哌酮舒巴坦较敏感,耐药率为0.92%~27.22%。铜绿假单胞菌对阿米卡星、庆大霉素耐药率较高,分别为57.19%和64.19%,对黏菌素、亚胺培南、美罗培南、头孢吡肟、哌拉西林他唑巴坦和头孢哌酮舒巴坦较敏感,耐药率为1.65%~27.33%。鲍曼不动杆菌对头孢哌酮舒巴坦及复方磺胺甲叶噁唑的耐药率相对较低,分别为37.69%和44.04%,对其他临床常见抗菌药物的耐药率均大于60%。结论:鉴于南阳市市区五家三级综合医院的细菌耐药情况,医院须加强细菌耐药监测和感染控制。

Monitoring and assessment on antimicrobial resistance of bacteria in 5 hospitals of Nanyang China 2013-2014

OBJECTIVE To monitor and assess antimicrobial resistance of bacteria in 5 hospitals of Nanyang city from 2013 to 2014.METHODS Cultivated bacteria were collected form 5 hospitals, positive rate, common bacterial species and results of drug sensitive test were summarized.RESULTS A total of 28755 bacteria were collected form 102318 specimens. The positive rate was 28.10%, gram-negative bacilli, gram-positive bacilli and fungi accounted for 71.95%, 20.01% and 8.04%, respectively. The most common isolates were escherichia coli(14.82%), klebsiella pneumoniae (13.75%), pseudomonas aeruginosa (12.41%), bauman acinetobacter (10.01%), coagulase negative staphylococcus (8.04%), staphylococcus aureus (5.16%). The detection rate of methicillin-resistant isolates were 56.81% and 76.95% in S.aureus (MRSA) and coagulase negative Staphylococcus (MRCNS). Detection rates of escherichia coli and klebsiella pneumoniae procing ESBLs were 59.99% and 38.71%, respectively. No vancomycin resistant isolate was found in staphylococcus. Resistance rates of staphylococcus strains to penicillin, cefuroxime and erythromycin were all higher than 80%, and it was sensitive to gentamicin and nitrofurantoin, the resistance rates were from 4.68% to 31.32%. Resistance rates of escherichia coli and klebsiella pneumonia to ampicillin, cefazolin, cefuroxime and ceftriaxone were 63.87% to 93.03%, and it was sensitive to imipenem, meropenem, nitrofurantoin, amikacin, piperacillin and tazobactam and cefoperazone and sulbactam, and the resistance rates were 0.92% to 27.22%. Resistance rates of pseudomonas aeruginosa to amikacin and gentamicin were 57.19% and 64.19%, and it was sensitive to Colistin, imipenem, meropenem, cefepime, piperacillin and tazobactam and cefoperazone and sulbactam, the resistance rates were 1.65% to 27.33%. Resistance rates of acinetobacter baumannii to cefoperazone and sulbactam and sulfamethoxazole were 37.69% and 44.04%, the resistance rates of acinetobacter baumannii to other common antibacterials were higher than 60%.CONCLUSION Bacterial resistances in urban area of Nanyang city were high. Hospital management should strengthen surveillance of bacterial resistance and infection control.