2014—2018年黄石市中心医院耐碳青霉烯类革兰阴性菌的分布及耐药性分析

目的 了解黄石市中心医院耐碳青霉烯类革兰阴性菌的分布及耐药性，为感染防控和临床治疗提供依据。方法 对2014—2018年黄石市中心医院耐碳青霉烯类革兰阴性菌的标本来源、科室分布、病原菌分布和耐药性进行统计分析。结果 2014—2018年，共分离出耐碳青霉烯类革兰阴性菌1 025株，分离率为8.01%，且分离率呈迂回上升趋势；所有标本和临床科室耐碳青霉烯类革兰阴性菌的分离率均呈迂回上升趋势。分离率排名前3位的标本分别为创面分泌物、痰液和脑脊液；分离率排名前3位的临床科室分别为ICU、神经外科和呼吸内科；分离率排名前3位的病原菌分别为鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌；耐碳青霉烯类革兰阴性菌对青霉素类、头孢菌素类和妥布霉素的耐药率在98%以上，亚胺培南和美罗培南耐药率在88%～97%，对阿米卡星耐药率在53%～77%，对复方复方新诺明的耐药率在72%～92%，对替加环素和多黏菌素耐药率为0。结论 黄石市中心医院耐碳青霉烯类革兰阴性菌的分离率呈上升趋势，以鲍曼不动杆菌上升最显著。应对耐碳青霉烯类革兰阴性菌的分离趋势和耐药性进行长期动态监测，为临床抗感染治疗提供参考数据。

Analysis on distribution and drug resistance of carbapenem-resistant Gram-negative bacteria in Huangshi Central Hospital from 2014 to 2018

Objective To understand the distribution and drug resistance of carbapenem-resistant Gram-negative bacteria in Huangshi Central Hospital, and provide basis for infection prevention and clinical antiinfection treatment. Methods Specimens source, department distribution, pathogenic bacteria distribution, and drug resistance of carbapenem-resistant Gram-negative bacteria in Huangshi Central Hospital from 2014 to 2018 were retrospectively analyzed. Results From 2014 to 2018, there were 1 025 cases of carbapenem- resistant Gram-negative bacteria were isolated, and the detection rate was 8.01%. The separation rate showed a round-trip trend. The isolation rate of carbapenem-resistant Gram-negative bacteria in all specimens and clinical departments all showed a round-trip trend. The top three specimens in the separation rate were wound secretion, sputum, and cerebrospinal fluid. The top three clinical departments in isolation rate were ICU, Department of Neurosurgery, and Department of Respiratory Medicine. The top three bacteria in the separation rate were Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The resistance rate of carbapenem-resistant Gram-negative bacteria against penicillins, cephalosporins, and tobramycin were above 98%, and the resistance rate against imipenem and meropenem were 88%-97%, and the resistance rate against amikacin were 53%-77%, and the resistance rate against sulfamethoxazole were 72%-92%, and the resistance rate against tigecycline and polymyxin were 0. Conclusion The isolation rate of carbapenem-resistant Gram-negative bacteria is on the rise, and the increase in A. baumannii is the most significant. Meanwhile, long-term dynamic monitoring of the separation tendency and drug resistance of carbapenem-resistant Gram-negative bacteria should be carried out to provide reference data for clinical anti-infective treatment.