2015-2017年医院临床分离菌分布特征及耐药情况动态分析

Dynamic analysis of distribution characteristics and drug resistance of clinical isolates in the hospital from 2015 to 2017

目的探究2015-2017年医院临床分离病原菌分布及耐药情况。方法收集2015年1月1日-2017年12月31日医院临床分离病原菌,采用VITEK2-Compact全自动细菌检测系统或纸片扩散法行药敏试验,药敏结果依据2015版美国临床实验室标准化研究所(CLSI)标准(CLSI M100-S25)判定,WHONET5.6软件分析数据,观察2015-2017年病原菌检出情况,分析主要病原菌对常用抗菌药物耐药性及多药耐药菌检出情况。结果2015-2017年共分离病原菌5 637株,2015-2017年检出病原菌均以革兰阴性菌为主,分别为918株占52.01%、1108株占56.04%、1150株占60.69%;2015-2017年耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为47.62%、44.57%、47.37%,产超广谱β内酰胺酶(ESBLs)大肠埃希菌检出率分别为62.38%、59.93%、50.64%;肺炎克雷伯菌对碳青霉烯类药物耐药率逐年递增;鲍氏不动杆菌复合群对替加环素耐药出现并逐年递增;铜绿假单胞菌对呋喃妥因、复方新诺明、多数头孢类药物、阿莫西林/克拉维酸耐药率居高。结论 2015-2017年医院临床病原菌主要为革兰阴性菌,分离菌对临床常用抗菌药物耐药率均较高,临床应高度重视多药耐药情况,加强耐药防控措施。

OBJECTIVE To investigate the distribution and drug resistance of clinical isolates from Dongfang Hospital from 2015 to 2017.METHODS The clinical isolates were collected from Jan 2015 to Dec.2017.The VITEK2-compact automatic bacterial detection system or disc diffusion method was used for drug susceptibility test.The drug susceptibility results were judged based on the 2015 version of the US Clinical Laboratory Standards Institute(CLSI)standard(CLSI M100-S25),and the data were analyzed using the WHONET 5.6 software.The detection of pathogens during 2015-2017 was observed,and the drug resistance of the main pathogens to common antimicrobial agents and the detection of multidrug-resistant organisms was analyzed.RESULTS A total of 5637 pathogens were isolated during 2015-2017,which were dominated by gram-negative bacteria,with 918 strains accounting for 52.01%,1108 strains accounting for 56.04%,1150 strains accounting for 60.69%in 2015-2017.The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)from 2015 to 2017 was 47.62%,44.57%and 47.37%,respectively.The detection rate of extended-spectrumβ-lactamases-producing Escherichia coli(ESBLs)from 2015 to 2017 was 62.38%,59.93% and 50.64%,respectively.The resistance rate of Klebsiella pneumoniae to carbapenems increased year by year,whereas the resistance of Acinetobacter baumannii to tigecycline occurred and increased year by year.The resistance rates of Pseudomonas aeruginosato nitrofurantoin,compound sulfamethoxazole,most of cephalosporins,cephalosporins and amoxicillin/clavulanic acid were high.CONCLUSION Gram-negative bacteria were the main pathogens in Dongfang Hospital from 2015 to 2017.The rate of antimicrobial resistance of the isolated bacteria to commonly used antimicrobial agents was high,so we should attach great importance to the situation of multidrug resistance and strengthen the measures of drug resistance prevention and control.