2010年湘潭市中心医院临床分离细菌耐药性监测研究

Surveillance of Antibiotic Resistance in Clinical Isolates from Central Hospital of Xiangtan in 2010

目的了解2010年湘潭市中心医院临床分离菌对常用抗菌药物的耐药性,为临床合理用药提供依据。方法采用K-B纸片法,对2010年临床分离菌2 789株进行药敏试验,采用WHONET统计软件对其结果进行分析。结果 2 789株细菌中,革兰阴性杆菌占76.6%(2 137/2 789),革兰阳性球菌占23.4%(652/2 789),分离菌占前6位分别是克雷伯菌属476株(17.1%)、不动杆菌属425株(15.2%)、大肠埃希菌413株(14.8%)、铜绿假单胞菌367株(13.2%)、金黄色葡萄球菌287株(10.3%)、凝固酶阴性葡萄球菌156株(5.6%)。体外药敏显示,大肠埃希菌产ESBL株检出率55.2%,克雷伯菌属为26.9%,肠杆菌科出现对碳青酶烯耐药株。铜绿假单胞菌和鲍曼不动杆菌中已分离出14.2%(52/367)和27.6%(118/425)的泛耐药株。MRSA和MRCNS分别为70.3%(201/287)和66.7%(104/156)。肠球菌属中未发现对万古霉素、替考拉宁、利奈唑胺耐药株。肺炎链球菌中,PRSA分离率占2.8%(2/72),PISA分离率占11.1%(8/72)。流感嗜血杆菌产β内酰胺酶检测率为10.8%。结论本院常见病原菌以革兰阴性杆菌为主,细菌多重耐药现象严重,特别是泛耐药铜绿假单胞菌和鲍曼不动杆菌增多。定期进行耐药性监测,有利于临床正确掌握医院细菌耐药的发展趋势,并为临床提供经验用药作参考。

Objective To investigate the antibiotic resistance of clinical strains isolated from Central Hospital of Xiangtan to antimicrobial agents commonly used in 2010,and to provide the evidence for rational use of antibiotics in clinical practice.Methods Kirby-Bauer method was used to test the susceptibility of 2,789 clinical isolates to antimicrobial agents.The results were analyzed by WHONET software.Results Of the 2,789 clinical isolates,Gram negative bacilli and Gram positive cocci accounted for 76.6%（2,137/2,789） and 23.4%（652/2,789）,respectively.The top six isolates were Klebsiella spp.（17.1%）,Acinetobacter spp.（15.2%）,Escherichia coli（14.8%）,Pseudomonas aeruginosa（13.2%）,Staphylococcus aureus（10.3%）,and coagulase negative staphylococci（5.6%）.In vitro chemosensitivity test revealed that the detection rates of ESBLs-producing E.coli and Klebsiella spp.were 55.2%% and 26.9%,respectively.Carbapenems resistant strains were found in Enterobacteriaceae spp.Pan-resistant strains were identified in 14.2%（52/367） of Pseudomonas aeruginosa isolates and 27.6%（118/425） of Acinetobacter baumannii.The prevalence rates of MRSA and MRCNS were 70.3%（201/287） and 66.7%（104/156）,respectively.No Enterococcus isolate was found resistant to vancomycin,teicoplanin or linezolid.The isolation rates of PRSA and PISA were 2.8%（2/72） and 11.1%（8/72）,respectively.Beta-lactamase was produced by 10.8% of the Haemophilus influenzae strains.Conclusions The major clinical pathogenic microorganisms in our hospital in 2010 were Gram negative bacilli.The prevalence of multi-drug resistant strains was increased,especially Pan-resistant Pseudomonas aeruginosa and Acinetobacter baumannii isolates.It is important and valuable to periodically investigate bacterial resistance surveillance for rational selection of antimicrobial agents.