2014年东莞市人民医院细菌耐药性监测

Surveillance of bacterial drug resistance in the peoples hospital of Dongguan in 2014

目的：了解2014年东莞市人民医院临床分离细菌对常用抗菌药物的耐药性。方法：流感嗜血杆菌、嗜麦芽窄食单胞菌采用纸片扩散法进行药敏试验，按CLSI2012年版标准判读结果。其余细菌采用法国生物梅里埃公司的全自动微生物鉴定分析仪（VITEK～2-Compact）进行菌株鉴定和药敏试验，超广谱-β内酰胺酶（ESBLS）、耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检测，采用该仪器配套试条的内置试验，用WHONET-5．5软件进行耐药性统计分析。结果：2014年检出细菌7535株；其中革兰阴性杆菌5701株，占75．7％，革兰阳性球菌1834株，占24．3％。居前5位的分离菌有鲍曼不动杆菌1387株，大肠埃希菌1367株，铜绿假单胞菌1062株，金黄色葡萄球菌743株，肺炎克雷伯菌694株。大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌的EsBLs检出率分别为：50．9％、34．0％、19．4％。MRSA和MRCNS检出率分别为20．6％和79．6％。未发现耐万古霉素的葡萄球菌，发现1株万古霉素耐药、1株中介的屎肠球菌，粪肠球菌对利奈唑胺耐药率为3％，屎肠球菌对利奈唑胺的耐药率为4．4％。肺炎链球菌对青霉素耐药率为13．1％。大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、弗劳地构橼酸杆菌对碳青霉烯类的耐药率在1．1％以下。铜绿假单胞菌对亚胺培南的耐药率为12％，鲍曼不动杆菌对亚胺培南的耐药率为67．2％。结论：每间医院或每个地区定期或持续性进行细菌耐药性监测，了解本院或地区的细菌耐药情况，耐药趋势，为院感防控、药学部门预警、临床选择抗菌药物提供参考是非常必要的。

Objective ： To understand the drug resistance of bacterials isolatecl from clinica in the People＇s Hospital in Dongguan in 2014. Methods ： Drug sensitivity of Haemophilus influenzae and Stenotrophomonas maltophilia were tested by disk diffusion method, according to the standard of 2012 CLSI. Drug sensitivity of other bacteria was tested by the productions of VITEK2-compact microbial analyzer from French BioMerieux Company, including ESBLs, MRSA and MRCNS, and the resistance was analyzed by WHONET-5.5 software.Results ： In 2014, there were 7535 bacteria strains, including 5701 strains of gram negative bacilli, accounting for 75.7%, and 1834 strains of gram positive cocci, accounted for 24.3%. Isolates of the top 5 were 1387 strains ofAcinetobacter baumanii, 1367 Escherichia coli, 1062 Pseudomonas aeruginosa, 743 Staphylococcus aureus, and 694 f Klebsiella pneumoniae. The positive rates of ESBLs in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were： 50.9%, 34%, and 19.4%, respectively. The detection rates of MRSA and MRCNS were 20.6% and 79.6%. There was no vancomycin resistant Staphylococcus, one strain of Enterococcus faecium resistant to vancomycin, and one intermediary. To linezolid, the resistant rate of Enterococcus faecalis was 3%, and Enterococcus faecium was 4.4%. The resistance rate of Pneumoniae to penicillin was 13.1%. The resistance rates to carbapenem of Escherichia coli, KlebsieUa pneumoniae, Enterobacter cloacae, and Citrobacter freundii were below 1.1%. The resistance rate to imipenem ofPseudomonas aeruginosa was 12%, and Acinetobacter baumanii was 67.2%. Conclusions ： The surveillance of bacterial resistance, understanding the situation of bacterial drug resistance, is very necessary for clinical selection of antibacterial drugs.