2005—2014年华中科技大学同济医学院附属同济医院细菌耐药性监测

Surveillance of antimicrobial resistance in clinical isolates from Tongji Hospital during the period from 2005 to 2014

目的分析武汉同济医院2005年1月—2014年12月临床分离细菌分布及其对常用抗菌药物耐药性变迁。方法采用纸片扩散法(K-B法)进行抗菌药物敏感性试验,E试验检测青霉素和头孢曲松对肺炎链球菌及万古霉素对葡萄球菌属的MIC。结果 10年间共获得非重复临床分离菌株56 205株,其中革兰阴性菌38 628株,占68.7%,革兰阳性菌17 577株,占31.3%。排名前5位的分离菌分别为大肠埃希菌、不动杆菌属、金黄色葡萄球菌(金葡菌)、克雷伯菌属和铜绿假单胞菌。10年间不动杆菌属分离率呈现逐年升高趋势,凝固酶阴性葡萄球菌呈现逐年下降趋势。甲氧西林耐药金葡菌(MRSA)和甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)的平均检出率分别为64.7%和79.8%,有逐年增高趋势。粪肠球菌在10年间维持对氨苄西林、青霉素、万古霉素、替考拉宁、利奈唑胺、高浓度庆大霉素、左氧氟沙星较高敏感率,而屎肠球菌对多种抗菌药物耐药率高,并呈现耐药率增高趋势,仅对万古霉素、替考拉宁、利奈唑胺耐药率较低。10年来,大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)、奇异变形杆菌中产ESBL菌株的比例呈逐年增长趋势,产ESBL菌株对检测抗菌药物敏感率均低于非产ESBL菌株。碳青霉烯类耐药的肠杆菌科细菌(CRE)近年增长显著。不发酵糖革兰阴性杆菌中不动杆菌属分离率逐渐增加并成为医院感染最常见的菌种,不动杆菌属对多种检测抗菌药物耐药率呈逐年上升趋势,而铜绿假单胞菌对测试抗菌药物仍保持较高的敏感率。结论细菌耐药性监测10年间,多重耐药菌分离率呈上升趋势,且多数临床分离菌也呈增长趋势,给临床治疗带来一定挑战。

Objective To investigate the distribution and changing antimicrobial resistance of bacterial strains isolated from patients in Tongii Hospitial during the period from January 2005 through December 2014. Methods Antimicrobial susceptibility was tested by Kirby-Bauer method. The minimum inhibitory concentrations of penicillin and ceftriaxone against Streptococcus pneumoniae and vancomycin against Staphyloccus spp. were determined by E-test. Results A total of 56 205 strains were isolated during the 10-year period, including gram-negative bacteria （38 628, 68.7%） and gram-positive bacteria （17 577, 31.3%）.The top five pathogenic bacterial species were Escherichia coli, Acinetobacter spp, S. aureus, Kelbsiella spp. and P. aeruginosa. The proportion of Acinetobacter isolates increased year by year during the lO-year period, but the proportion of coagulase-negative Staphylococcus was on decline. The average prevalence of methicillin resistant strains in S.aureus and coagulase-negative Staphylococcus was 64.7% and 79.8%, respectively with an increasing trend during the 10-year period. The Enterococcus faecalis strains still showed high susceptibility rate to ampicillin, penicillin, vancomycin, teicoplanin, linezolid, gentamicin （high level）. But the E. faeeium isolates were highly resistant to most antimicrobial agents except vancomycin, teicoplanin, and linezolid. Over the 10-year period, the prevalencce of ESBLs-producing strains in Escherichia coli, Klebsiella spp. （K. pneumoniae and K. oxytoca）, and Proteus mirabilis showed an increasing trend. The ESBLs-producing strains were always more resistant than the corresponding non-ESBLs-producing strains. The growth of carbapenem-resistant Enterobacteriaceae was remarkable in the last two years. The number ofAcinetobacter spp. strains gradually increased in recent years and became one of the most common pathogens of nosocomial infection. The resistance rates of Acinetobacter spp. to multiple antimicrobial agents were on the rise, while the susceptibility profile ofP. aeruginosa remained stable over years. Conclusions Surveillance of bacterial resistance in hospitals across China during the 2005-2014 period showed that the prevalence of multi-drug resistant bacteria was on the rise. The increasing resistance of common pathogens has become a maior challenge to clinical nractiee.