2017年山东省千佛山医院临床病原菌分布和耐药性分析

Analysis of clinical pathogen distribution and drug resistance in Shandong Provincial Qianfoshan Hospital in 2017

目的:了解2017年山东千佛山医院临床细菌分离株的分布及耐药性,为临床合理使用抗生素提供依据.方法:通过Bruker MALDI-TOF、Walkaway 96 plus或VITEK-2 Compact自动化细菌鉴定仪进行细菌鉴定,纸片扩散法、Walkaway 96 plus或VITEK-2 Compact自动化药敏系统进行药物敏感性测定.药敏按照2016年CLSIM100中规定的折点,使用WHONET 5.6软件分析数据.结果:2017年1月~12月共检出6511株临床分离株,其中革兰氏阴性菌和革兰阳性球菌分别占74.5%和25.5%.前五种病原体分别是大肠杆菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌.对甲氧西林耐药的金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)分离率分别为25.5%和77.6%.没有检测到对万古霉素,替考拉宁或利奈唑胺耐药的葡萄球菌.4.3%的屎肠球菌菌株对万古霉素耐药.分离出239株耐碳青霉烯的肠杆菌科细菌,占所有肠杆菌科分离株的8.5%.不动杆菌属对亚胺培南和美罗培南耐药率分别为81.7%和83%.铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为34.2%和32.4%.结论:我院的多重耐药细菌形势严峻,应加强医院感染控制和抗菌药物临床使用管理,保持良好的细菌耐药性监测.

Objective: To investigate the distribution and antimicrobial resistanee profile of clinical bacterial isolates in Qianfoshan Hospital ofShandong Province in 2017, so as to provide information for guiding the rational use ofantibiotics in clinical practice. Methods: Bacteria identification was performed by Bmker MALDI—TOF, Walkaway 96 plus or the VITEK—— Compact automatic identification system. Disk diffusion susceptibility testing, Walkaway 96 plus or VITEK —— Compact automatic identification system were used to determine the susceptibility to antimicrobial agents. The results were analyzed according to CLSI 2016 breakpoints.AU data were analyzed using WHONET 5.6 software. Results: A total of 6511 clinical isolates were collected fromJanuary to December 2017, ofwhich gram-negative organisms and gram -positive cocci accounted for 74.5% and 25.5%, respectively. The top five pathogens were E. coli, K. pneumoniae, P. aeruginosa, A. baumannii and S. aureus. The prevalence ofmethicillin—resistant S aureus (MRSA) and coagulase negative staphylococcus (MRCNS) was 25.5% and 77.6% respectively. No staphylococcal strains were resistant to vancomycin, teicoplanin or linezolid. 4.3% of E. faecium strains were resistant to vancomycin. 239 strains of carbapenem —resistant Enterobacteriaceae were isolated, which accounted for 8.5% of all the Enterobacteriaceae isolates. About 81.7% and 83% of Acinetobacter spp. strains were resistant to iniipenem and nieropenerrL With respect to P aeruginosa, the resistance rates to iinipenem and meropenem were 34.2% and 32.4%, respectively. Conclusion: The prevalence of multi —drug resistant bacteria is high in our hospital. It is necessary to strengthen hospital infection control and management ofclinical use ofantimicrobial agents, and maintain good practice in surveillance ofbacterial resistance.