临床分离菌对常用抗生素的耐药性监测

Surveillance of the antimicrobial resistance of clinical isolates to antibiotics

目的监测浙江医院2012年10月-2013年10月临床分离菌对常用抗生素的耐药性。方法采用VITEK2Compact对所有菌株进行鉴定与药敏试验,参照CLSI2013年版判读结果,使用WHONET 5.6软件进行统计分析。结果共收集非重复临床菌2 491株。革兰阴性菌占全部菌株的77.1%,革兰阳性菌占22.9%。呼吸道标本最多,占48.5%。大肠埃希菌中未发现对亚胺培南耐药的菌株,而在肺炎克雷伯菌中的耐药率为33.4%。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别达50.6%和93.5%。金黄色葡萄球菌对苯唑西林的耐药率为91.3%,未发现对利奈唑胺,万古霉素和替考拉宁耐药的葡萄球菌。屎肠球菌的耐药性,除四环素外,均高于粪肠球菌。两者对万古霉素的耐药率分别为45.6%和0。未发现对利奈唑胺耐药的肠球菌。结论浙江医院的临床分离株耐药率高,应重视细菌耐药性监测,掌握细菌耐药动向和变迁,更有效的指导临床合理用药。

Objective To investigate the antimicrobial resistance of clinical isolates to common antibiotics in Zhejiang Hospital from Oct. 2012 to Oct. 2013. Methods Identification and antibiotic susceptibility testing of all strains was conducted by VITEK Compact. The final results were analyzed by WHONET5. 6 software according to CLSI 2013. Results In 2491 unique isolates during this period,gram- negative bacteria accounted for 77. 1%,and gram positive bacteria accounted for 22. 9%. Most bacterial strains were isolated from respiratory tract specimens,accounting for 48. 5%. No strains were found resistant to imipenem in Escherichia coli isolates,while the drug resistance rate of Klebsiella pneumonia isolates to imipenem was 33. 4%. The drug resistance rates of Pseudomonas aeruginosa and Acinetobacter baumanni to imipenem were 50. 6% and 93. 5%,respectively.The drug resistance rate of Staphylococus aureus isolates to oxacillin was 91. 3%,but no strains were found resistant to linezolid,vancomycin and teicoplanin in Staphylococus spp. The resistance rates of Enterococcus faecium to common antibiotics were higher than Enterococcus faecalis except tetracycline. No strains were resistant to linezolid in Enterococcus spp. The resistance rates of E. faecium and E. faecalis were 45. 6% and 0% to vacomycin,respectively. Conclusion The clinical isolates from Zhejiang Hospital showed high resistance to the common antibiotics,indicating that more attention should be paid to bacterial drug resistance surveillance to grasp the changes trend of drug resistance,thus guiding more effective and rational use of clinical antibiotics.