2013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 2013

目的了解安徽省铜陵市人民医院2013年临床分离细菌对抗菌药物的耐药状况。方法共收集2013年临床分离的2 281株非重复细菌,采用纸片扩散法(K-B)进行药敏试验,按CLSI 2012年版标准判读药敏试验结果,采用WHONET5.6软件进行数据分析。结果分离菌中革兰阴性菌占76.5%,革兰阳性菌占23.5%。居前5位的分离菌依次为:大肠埃希菌479株(21.0%)、肺炎克雷伯菌360株(15.8%)、鲍曼不动杆菌271株(11.9%)、铜绿假单胞菌240株(10.5%)、金黄色葡萄球菌(金葡菌)171株(7.5%)。耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别占金葡菌和凝固酶阴性葡萄球菌的38.6%和73.1%。甲氧西林耐药株对β内酰胺类抗生素和其他测试抗菌药物的耐药率显著高于甲氧西林敏感株;未发现对万古霉素和替考拉宁耐药的葡萄球菌。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产ESBL的检出率分别为50.5%和44.5%,产ESBL菌株对大多数抗菌药物的耐药率明显高于非产ESBL菌株。检出对碳青霉烯类抗生素耐药的克雷伯菌属81株(21.8%,81/371)和大肠埃希菌8株(1.7%,8/479)。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为75.0%和76.0%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为29.8%和23.4%,对阿米卡星的敏感率最高,为94.0%。结论该院临床分离菌对抗菌药物的耐药性呈增长趋势,尤其耐碳青霉烯类肠杆菌科细菌的出现应引起高度关注,应加强抗菌药物的合理使用和医院感染控制措施。

Objective To investigate the antimicrobial resistance of clinical isolates in Tongling People＇s Hospital during 2013. Methods A total of 2 281 nonduplicate clinical isolates were collected. Kirby-Bauer disc diffusion method was employed to study the antimicrobial susceptibility. The data were analyzed with WHONET 5. 6 software according to CLSI 2012 breakpoints. Results The top 5 most frequently isolated microorganisms were E. coli （479,21.0%）, K. pneumoniae （360,15.8%）, A. baumannii （271, 11. 9%）, P. aeruginosa （240, 10. 5%）, S. aureus （171,7. 5%）. Gram negative and gram positive microorganisms accounted for 76. 5% and 23. 5%, respectively. The prevalence of methicillin resistant strains in S. aureus （MRSA） and coagulase negative Staphylococcus （MRCNS） was 38.6% and 73.1%, respectively. The resistance rates of MR strains to beta-lactams and other antimicrobial agents were much higher than those of MS strains. 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 antibiotics tested. Approximately 50.5% of E. coli and 44. 5% of Klebsiella isolates produced extended-spectrum beta-lactamases （ESBLs）. The ESBLs producing strains were significantly more resistant to most of the antibiotics than the corresponding non-ESBLs-producing strains. The prevalence of carbapenem-resistant strains was 21.8% （81/371） inKlebsiella spp. and 1.7%（8/479） in E. coli. The percentage of A. baumannii strains resistant to imipenem and meropenem was 75. 0% and 76. 0%, respectively. And 29. 8% and 23.4% of the P. aeruginosa strains were resistant to imipenem and meropenem. Nearly all （94.0%） P. aeruginosa isolates were susceptible to amikacin. Conclusions There appears a trend of increasing resistance in the clinical bacterial isolates in this hospital, especially the carbapenem resistant Enterobacteriaceae, which is of great concern. It is mandatory to take effective antibiotic policy and infection control measures.