2478株临床分离细菌和念珠菌的分布特征和耐药谱分析

Distribution and drug resistance spectrum analysis of 2478 clinical bacterial and Candida isolates

目的了解本院临床分离细菌和念珠菌的分布特征、耐药谱和耐药机制,为合理使用抗生素提供依据。方法大多数分离细菌的鉴定和药敏试验利用BD Phoenix仪,少数利用手工鉴定和Kirby-Bauer法。念珠菌利用显色平板分离和鉴定,K-B法药敏。数据分析用WHONET5软件。结果2478株细菌和念珠菌中前6位为铜绿假单胞菌15.6%、大肠埃希菌11.5%、白色念珠菌9.6%、肺炎克雷伯菌9.3%、金黄色葡萄球菌8.2%、表皮葡萄球菌7.5%。革兰氏阴性杆菌合计耐药率较低的为美洛培南14.4%、头孢哌酮/舒巴坦14.8%、亚安培南21.9%、哌拉西林-他唑巴坦27.4%、头孢他啶30.0%、阿米卡星31.1%、头孢吡肟33.1%。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的检出率为47.4%和37.3%。革兰氏阳性球菌合计耐药率较低的为万古霉素0.9%、替考拉宁1.1%、呋喃妥因6.9%、阿米卡星20.1%、氯霉素30.7%、头孢哌酮/舒巴坦31.5%。金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌甲氧西林耐药率为57.1%、65.0%和66.0%。念珠菌合计对常用抗真菌药物的耐药率为两性霉素B0.3%、制菌霉素的0.3%、伊曲康唑5.6%、氟康唑9.4%和氟胞嘧啶9.4%。结论本院临床细菌产ESBLs和苯唑西林耐药率较高,应加强抗生素的合理使用以降低耐药率,采取有效的隔离措施以减少多重耐药菌的扩散。

Objective To investigate the distribution and drug resistance spectrum of clinical bacterial and Candida isolates, Methods Most of the bacterial isolates were identified using automated BD Phoenix, and a few with K-B method carried out manually. Candida isolates were identified by color-display plate and K-B method, Results The most common isolates in the 2478 strains were P. aeruginosa （15.6%）, E. coli （11.5%）, C. albicans （9,6%）, K. pneumoniae （9.3%）, S. aureu （8.2%）, and S. epidermidis （7.5%）. In gram-negative isolates, the antibiotics with the lowest resistance rate were meraopenem （14.4%）, cefoperazone/Sulbactam （14.8%）, Imipenem （21.9%）, piperacillirdtazobactam （27.4%）, ceftazidime （30.0%）, amikacin （31.1%）, and cefepime （33.1%）. The detection rate of E.coli and K. pneumoniae isolates producing extended spectrum beta-lactamase （ESBLs） were 47.4% and 37.3% respectively, In gram-positive isolates, the antibiotics with the lowest resistance rate were vancomycin （0.9%）, teicoplanin （1.1%）, nitrofurantoin （6.9%）, amikacin （20.1%）, chloramphenicol （30.7%）, and cefoperazone/sulbactam （31.5%）. The methecillin-resistant rates of S. aureu, S. epidermidis, and S. haemolytieus were 57.1%, 65.0%, and 66.0%. For Candida isolates, the most sensitive antibiotics were amphotericin B （0.3%）, nystain （0.3%）, itraconazole （5.6%）, fluconazole（9.4%）, and fluorocytosine （9.4%）. Conclusion The results suggest high rate of ESBL production and oxacillin resistance of the bacteria isolated in the hospital. More rational use of antimicrobial agents is crucial for reducing the drug-resistance of the bacteria, and effective measures must be taken to reduce dissemination of multidrug-resistant bacteria,