2015年宁波市某二级医院细菌耐药性监测

Surveillance of bacterial resistance in one secondary hospital in Ningbo during 2015

目的了解宁波市镇海龙赛医院2015年临床分离细菌分布和耐药特征,为临床合理选择抗菌药物提供依据。方法收集临床分离的1083株非重复细菌,采用纸片扩散法(K-B)进行药敏试验,按CLSI 2014年版标准判读药敏试验结果,采用WHONET5.6软件进行数据分析。结果分离菌中革兰阴性菌726株占67.0%,革兰阳性菌357株占33.0%。居前3位的细菌依次为:大肠埃希菌25.5%、肺炎克雷伯菌11.5%、铜绿假单胞菌9.2%,而鲍曼不动杆菌仅为3.8%。大肠埃希菌、克雷伯菌属细菌产超广谱β-内酰胺酶(ESBL)株的检出率分别为49.6%和53.6%。耐亚胺培南的大肠埃希菌和肺炎克雷伯菌的比例分别为0.4%和0.8%。铜绿假单胞菌和鲍曼不动杆菌对所监测药物的耐药率都低于20%,其中碳青霉烯类耐药的鲍曼不动杆菌(CRAB)比例仅为9.8%,未分离到泛耐药的铜绿假单胞菌和鲍曼不动杆菌。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(MRCNA)的检出率分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的53.2%和70.1%,未发现对万古霉素和替考拉宁耐药的葡萄球菌。未分离出耐万古霉素的链球菌属、肠球菌属细菌。万古霉素仍是对革兰阳性球菌抗菌活性最强的药物,碳青霉烯类药物对肠杆菌科等革兰阴性杆菌抗菌活性最强。结论与三甲医院细菌耐药性监测相比,本二级医院分离耐药菌的构成比及药物敏感性存在差异,鲍曼不动杆菌检出率低,耐药水平较低。

Objective To investigate the distribution and anfimicrobial resistance profile of clinical isolates in Zhenhai Longsai Hospital of Ningbo during 2015. To provide the guidance for rational clinical choice of antibiotics. Methods A total of 1,083 non,duplicate clinical isolates were collected. The Kirby-Bauer disc diffusion method was employed to study the antimicrobial susceptibility. The data were analyzed with WHONET 5.6 software according to CLSI 2014 breakpoints. Results Gram-negative and Gram-positive microorganisms accounted for （726, 67.0%） and （357, 33.0%）, respectively. The top three most frequently isolated microorganisms were E. coli （25.5%）, K. pneumoniae （11.5%） and P. aeruginosa （9.2%）, and the isolated rote ofA. baumannii was only 3.8%. The prevalence of ESBLs producing sWains was 49.6% in E. coli, and 53.6% in Klebsiella spp., and 0.4% E. coli isolates and 0.8% Klebsiellapneumonia isolates were resistant to imipenem. The resistance rotes of P. aeruginosa and A. baumannii to the tested drugs were under 20%. Only 9.8% carbapenems-resistant A. banmannii （CRAB） were detected, and no pan-drug-resistant P. aeruginosa and A. banmannii were found. The prevalence of methiciUin- resistant swains in S. aureus （MRSA）and coagulase negative Staphylococcus （MR CNS） were 53.2% （50/94） and 70.1% （ 101/144）, respectively. No staphylococcal strains were found resistant to vancomycin or teicoplanin. None of the Streptococcus and Enterococcus isolates were found resistant to vancomycin. Vancomycin was still the most active antimicrobial against Gram- positive, and carbapenems were the most active antimicorobial against Gram-negative isolates, such as Enterobacteriaceae. Conclusion Compared with the bacterial resistance surveillance on the teaching hospitals, secondary hospital showed large differences in the composition of drug-resistant bacteria and drug susceptibility. The isolating rate and the resistance rate of A. baumanii were low.