2013-2014年南阳市市区五家三级综合医院细菌耐药监测评价

Monitoring and assessment on antimicrobial resistance of bacteria in 5 hospitals of Nanyang China 2013-2014

目的：监测评价2013—2014年南阳市市区五家三级综合医院检出菌分布和耐药情况。方法：收集五家医院临床分离菌信息，对细菌培养阳性率、常见分离菌种类、细菌药敏结果等进行统计分析。结果：五家医院两年共送检标本102318例，其中检出28755例，检出阳性率为28．10％。分离的28755株细菌中革兰阳性菌5755株（占20．01％），革兰阴性菌20689株（占71．95％），真菌2311株（占8．04％）。主要检出菌为大肠埃希菌（占14．82％）、肺炎克雷伯菌（占13．75％）、铜绿假单胞菌（占12．41％）、鲍曼不动杆菌（占10．01％）、凝固酶阴性葡萄球菌（占8．04％）、金黄色葡萄球菌（占5．16%）等。MRSA及MRC—NS的检出率分别为56．81％和76．95％，大肠杆菌属和肺炎克雷伯菌属产超广谱p内酰胺酶菌的检出率分别为59．99％和38．71％，未检出对万古霉素耐药的葡萄球菌。葡萄球菌对青霉素、头孢呋辛、红霉素耐药率在80％以上，对庆大霉素、呋喃妥因较敏感，耐药率在4．68％～31．32％之间。大肠埃希菌和肺炎克雷伯菌对氨苄西林、头孢唑林、头孢呋辛、头孢曲松耐药率在63．87％～93．03％之间，对亚胺培南、美罗培南、呋喃妥因、阿米卡星、哌拉西林他唑巴坦和头孢哌酮舒巴坦较敏感，耐药率为0．92％～27．22oA。铜绿假单胞菌对阿米卡星、庆大霉素耐药率较高，分别为57．19％和64．19％，对黏菌素、亚胺培南、美罗培南、头孢吡肟、哌拉西林他唑巴坦和头孢哌酮舒巴坦较敏感，耐药率为1．65％～27．33％。鲍曼不动杆菌对头孢哌酮舒巴坦及复方磺胺甲-恶唑的耐药率相对较低，分别为37．69％和44．04％，对其他临床常见抗菌药物的耐药率均大于60％。结论：鉴于南阳市市区五家三级综合医院的细菌耐药情况，医院须加强细菌耐药监测和感染控制。

OBJECTIVE To monitor and assess antimicrobial resistance of bacteria in 5 hospitals of Nanyang city from 2013 to 2014. METHODS Cultivated bacteria were collected form 5 hospitals, positive rate, common bacterial species and results of drug sensitive test were summarized. RESULTS A total of 28755 bacteria were collected form 102318 specimens. The positive rate was 28. 10%, gram-negative bacilli, gram-positive bacilli and fungi accounted for 71.95%, 20. 01% and 8. 04%, respectively. The most common isolates were escherichia coli（14. 82%）, klebsiella pneumoniae （13. 75%）, pseudomonas aeruginosa （12. 41%）, bauman acinetobacter （10. 01%）, coagulase negative staphylococcus （8. 04%）, staphylococcus aureus （5.16%）. The detection rate of methicillin-resistant isolates were 56. 81% and 76. 95% in S. aureus （MRSA） and coagulase negative Staphylococcus （MRCNS）. Detection rates of escherichia coli and klebsiella pneumoniae procing ESBLs were 59. 99% and 38.71%, respectively. No vancomycin resistant isolate was found in staphylococcus. Resistance rates of staphylococcus strains to penicillin, cefuroxime and erythromycin were all higher than 80%, and it was sensitive to gentamicin and nitrofurantoin, the resistance rates were from 4. 68% to 31.32%. Resistance rates of escherichia coli and klebsiella pneumonia to ampicillin, cefazolin, cefuroxime and ceftriaxone were 63.87% to 93.03%, and it was sensitive to imipenem, meropenem, nitrofurantoin, amikacin, piperacillin and tazobactam and cefoperazone and sulbactam, and the resistance rates were 0. 92% to 27. 22%. Resistance rates of pseudomonas aeruginosa to amikacin and gentamicin were 57. 19% and 64. 19%, and it was sensitive to Coilstin, imipenem, meropenem, cefepime, piperacillin and tazobactam and cefoperazone and sulbactam, the resistance rates were 1.65% to 27. 33%. Resistance rates of acinetobacter baumannii to cefoperazone and sulbactam and sulfamethoxazole were 37. 69% and 44. 04%, the resistance rates of acinetobacter baumannii to other common antibacterials were higher than 60%. CONCLUSION Bacterial resistances in urban area of Nanyang city were high. Hospital management should strengthen surveillance of bacterial resistance and infection control.