某院近五年多重耐药菌分布及耐药性分析

Analysis of distribution and drug resistance of multidrug-resistant organisms

目的了解医院感染多重耐药菌（MDROs）的分布特征及耐药性。方法回顾性分析2010~2014年该院分离的MDROs分布特征及耐药性,按国际标准化建议的共识方法对不同MDROs进行定义;采用WHONET5.6软件进行数据统计处理。结果 2010~2014年共分离MDROs 5 709株,其中葡萄球菌2 441株（42.76%）,非发酵菌2 091株（36.63%）,肠球菌737株（12.90%）,肠杆菌科细菌440株（7.71%）。5 709株MDROs主要来自呼吸道标本（55.04%）。多重耐药大肠埃希菌和肺炎克雷伯菌对头孢哌酮/舒巴坦、亚胺培南、美罗培南的耐药率小于30%;多重耐药鲍曼不动杆菌对米诺环素、头孢哌酮/舒巴坦的耐药率为20.2%、50.6%,对其余抗菌药物的耐药率均超过90%;除多黏菌素B外,多重耐药铜绿假单胞菌对其余抗菌药物的耐药率为71.4%~97.0%;多重耐药屎肠球菌对米诺环素的耐药率为13.8%,对利奈唑胺、替考拉宁、万古霉素的耐药率小于3%,对其余抗菌药物的耐药率均超过90%。1 914株耐甲氧西林金黄色葡萄球菌（MRSA）中检出1株利奈唑胺耐药菌株,未检出万古霉素、替考拉宁耐药菌株。结论该院MDROs主要以鲍曼不动杆菌和MRSA占优势,应加强医院感染监测和采取有效的感染控制措施,以防止MDROs播散。

Objective To investigate the distribution and antimicrobial resistance of multidrug-resistant organisms（MDROs）.Methods The distribution and antimicrobial resistance of MDROs,isolated from 2010 to 2014,were retrospectively analyzed.MDROs were identified according to international consensus.The WHONET5.6software was used to analyze data.Results A total of 5 709 strains of MDROs were isolated in five years,in which 2 441 strains were Staphylococcus（42.76%）,2 091 strains were non-fermentive bacterial（36.63%）,737 strains were Enterococcus（12.90%）,440 strains were Enterobacter（7.71%）.Of the 5 709 MDROs isolates,55.04% were isolated from respiratory tract specimens.The resistant rate of multidrug-resistant E.coli and K.pneumoniae against cefoperazone/sulbactam,imipenem and meropenem was less than 30%.The resistance of multidrug-resistant A.baumanii was higher than 90%,except to minocycline and cefoperazone/sulbactam,20.2% and 50.6% respectively.The resistant rate of multidrug-resistant P.aeruginosa was 71.4%-97.0%against other antimicrobial agents,except to polymyxin B.The resistance of multidrug-resistant E.faecium against the antimicrobials was higher than 90%,except 13.8% to minocycline and less than 3%to linezolid,teicoplanin and vancomycin.Meanwhile,1 linezolid resistant strain was identified in 1 914 methicillin resistant S.aureus（MRSA）strains and all MRSA strains were susceptible to vancomycin and teicoplanin.Conclusion MDROs could be predominated by A.bauman and MRSA in this hospital.Monitoring and control measures to healthcare-associated infections should be intensified to prevent the spread of MDROs.