2014年重庆医科大学附属第一医院细菌耐药性监测

Bacterial drug resistance surveillance in First Affiliated Hospital of Chongqing Medical University during 2014

目的了解重庆医科大学附属第一医院临床分离菌对常用抗菌药物的耐药性。方法对该院2014年1~12月收集的临床分离菌进行细菌药物敏感试验,结果按美国临床和实验室标准协会（CLSI）2014年版标准判断。结果临床分离菌共7 740株,其中革兰阳性菌占29.4%,革兰阴性菌占70.6%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株分别为30.2%和77.2%。葡萄球菌属中甲氧西林耐药株对主要药物的耐药率显著高于甲氧西林敏感株,未发现对万古霉素及利奈唑胺耐药的菌株。肠球菌属中粪肠球菌对主要抗菌药物的耐药率低于屎肠球菌,屎肠球菌有少数万古霉素耐药株（2.3%）,出现少数耐利奈唑胺的粪肠球菌（0.9%）。大肠埃希菌、肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）的阳性分别为59.5%和31.8%。肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感,总耐药率小于2.0%。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为24.5%和17.9%,鲍曼不动杆菌对两者的耐药率分别为71.9%和75.0%。多重耐药肺炎克雷伯菌和鲍曼不动杆菌增加明显。结论细菌耐药性严重,尤其是多重耐药菌对临床构成严重威胁。合理选用抗菌药物,加强感染控制措施是当务之急。

Objective To investigate the resistance of clinically isolated bacteria to commonly used antibacterial drugs in the First Affiliated Hospital of Chongqing Medical University.Methods The bacterial susceptibility testing in clinically isolated bacteria collected during January to December 2014 was carried out.The detection results were judged according to the standards by CLSI in 2014.Results Among 7 740 clinical isolated strains of bacteria collected during this period,Gram negative bacteria and Gram positive bacteria accounted for 70.6% and 29.4% respectively.Methicillin resistant（MR）strains in S.aureus and coagulase negative Staphylococcus accounted for 30.2% and 77.2% respectively.The resistance rates of MR strains to main antimicrobial agents were much higher than those of methicillin sensitive（MS）strains.No staphylococcal strain was resistant to vancomycin or linezolid.The resistance rates of E.faecalis strains to main antibacterial agents was much lower than those of E.faecium.Some strains（2.3%）of E.faecium were found resistant to vancomycin,while some strains（0.9%）of E.faecalis were found resistant to linezolid.The ESBLs producing strains were 59.5%in Escherichia coli and 31.8%in Klebsiella pneumoniae.Strains of Enterobacteriaceae were highly susceptible to imipenem and meropenem,the overall resistance rates being less than 2.0%.Resistance rates of P.aeruginosa to imipenem and meropenem were 24.5% and 17.9%,respectively.The resistance rates of A.baumanii to the two carbapenems were 71.9% and 75.0%,respectively.The multi-drug resistant K.pneumoniae and A.baumanii were increased markedly.Conclusion Bacterial drug resistance is serious,especially the multi-drug resistant bacteria constitute a serious threat to clinic.Therefore it is urgent to strengthen the infection control measures.