2012年铜陵市人民医院细菌耐药性监测

Surveillance of bacterial resistance in Tongling People′s Hospital during 2012

目的了解铜陵市人民医院2012年临床分离菌对抗菌药物的耐药状况。方法共收集临床分离的非重复细菌2 002株,采用纸片扩散法(K-B)进行药敏试验,结果按CLSI 2012年版标准判读,采用WHONET5.6软件进行数据分析。结果居前6位的细菌依次为:大肠埃希菌379株(18.9%)、鲍曼不动杆菌256株(12.8%)、肺炎克雷伯菌243株(12.1%)、铜绿假单胞菌192株(9.6%)、凝固酶阴性葡萄球菌(CNS)184株(9.2%)、金葡菌170株(8.5%)。其中革兰阴性菌占71.4%,革兰阳性菌占28.6%。甲氧西林耐药金葡菌和CNS(MRSA和MRCNS)的检出率分别为47.6%和72.8%。MRSA和MRCNS对β内酰胺类抗生素和庆大霉素、左氧氟沙星、红霉素和克林霉素均高度耐药,未发现对万古霉素和替考拉宁耐药的葡萄球菌属。粪肠球菌对青霉素、氨苄西林、呋喃妥因的耐药率较低,屎肠球菌对大多数抗菌药物的耐药率明显高于粪肠球菌。大肠埃希菌和克雷伯菌属中ESBLs的检出率分别为50.4%和38.0%,产ESBLs菌株对大多数抗菌药物的耐药率明显高于非产ESBLs菌株。检出耐碳青霉烯类克雷伯菌(21.2%,54/255)和大肠埃希菌(0.8%,3/379)。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为84.0%和94.4%,对头孢哌酮-舒巴坦和米诺环素的敏感率较高,分别为69.9%和42.6%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为25.5%和24.6%,对阿米卡星的敏感率最高,为94.8%。结论该院细菌对抗菌药物的耐药性呈增强趋势,已发现耐碳青霉烯类克雷伯菌属和大肠埃希菌,应加强抗菌药物的合理使用和医院感染控制。

Objective To investigate the antimicrobial resistance of clinical isolates from Tongling Peoplets Hospital during 2012. Methods A total of 2002 nonduplicate clinical isolates were collected. Disc diffusion test （Kirby-Bauer method） was em-ployed to study the antimicrobial resistance. The data were analyzed by WHONET 5.6 software according to CLSI 2012 break-points. Results The top 6 most frequently isolated microorganisms were E. coli （379, 18.9%）, A. baumannii （256, 12.8%）, K. pneumoniae （243, 12.1%）, P. aeruginosa （192, 9.6 % ）, coagulase negative Staphylococcus （184, 9.2%）, S. aureus （170, 8.5%）. Gram negative organisms and gram positive organisms accounted for 71.4% and 28.6%, respectively. The prevalence of methicillin-resistant strains in S. aureus （MRSA） and coagulase negative Staphylococcus （MRCNS） was 47.6% and 72.8%, respectively. The MRSA and MRCNS were highly resistant to beta-lactam antibiotics, gentamicin, levofloxacin, erythromycin and clindamycin. No staphylococcal strain was found resistant to vancomycin or teicoplanin. E. faecalis showed relatively lower resistance to penicillin, ampicillin and nitrofurantoin. E. faecium strains were more resistant than E. faecalis to most of the antibotics tested. Approximately 50. 4% of E. coli and 38.0 % of Klebsiella isolates produced extended- spectrum beta-lactamases （ESBLs）. The ESBLs-producing strains were significantly more resistant to most of the anti-biotics than the corresponding non-ESBLs-producing strains. The prevalence of carbapenem-resistant strains was 21.2% （54/255） in Klebsiella spp. and 0.8% （3/379） in E. coli. The percentage of the A. baumannii strains resistant to imipenem and meropenem was 84.0% and 94.4%, respectively. A. baumannii isolates were relatively susceptible to cefoperazone-sul-bactam and minocyeline （69.9% and 42.6% susceptile, respectively）. And 25.5% and 24.6% of P. aeruginosa strains were resistant to imipenem and meropenem. Nearly all （94.8%） P. aeruginosa isolates were susceptible to amikacin. Conclusions There appears a trend of increasing resistance in the clinical bacterial isolates in this hospital. Carbapenem-resistant Klebsiella and E. coli strains are identified. It is mandatory to take effective antibiotic policy and infection control measures.