广西百色某三级甲等医院2015年度细菌耐药性监测

Antimicrobial resistance in a class A tertiary hospital in Baise,Guangxi Province:2015 surveillance report

目的了解广西右江民族医学院附属医院临床常见分离菌的分布及耐药性。方法收集该院2015年1-12月临床住院患者标本的分离细菌,采用VITEK 2-Compact及纸片扩散(K-B)法进行药敏试验,按CLSI 2014版折点判断结果,并采用WHONET 5.6软件进行统计分析。结果从临床住院患者标本中共分离到细菌4 004株,其中革兰阳性菌1 146株占28.6%,革兰阴性菌2 858株占71.4%。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(MRSA和MRCNS)的检出率分别为25.8%和79.4%。甲氧西林耐药株对除甲氧苄啶-磺胺甲唑之外的测试抗菌药物的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS)。肺炎链球菌以非脑膜炎菌株为主,非脑膜炎菌株对大环内酯类、四环素耐药率很高,对喹诺酮类耐药率很低。肠球菌属以屎肠球菌和粪肠球菌为主,屎肠球菌对高浓度庆大霉素和高浓度链霉素的耐药率高于粪肠球菌。除克林霉素和四环素外,粪肠球菌对多数测试抗菌药物的耐药率显著低于屎肠球菌。未检出万古霉素、利奈唑胺和替加环素耐药的革兰阳性球菌。大肠埃希菌和肺炎克雷伯菌中产ESBL菌株分别为53.1%和28.5%。肠杆菌科细菌对碳青霉烯类敏感率仍很高,大肠埃希菌对除哌拉西林-他唑巴坦和碳青霉烯类之外测试药物的耐药率要显著高于其他肠杆菌科细菌。肠杆菌科细菌对甲氧苄啶-磺胺甲唑的耐药率要高于其他测试药物。铜绿假单胞菌对所有测试药物的耐药率均<10%,鲍曼不动杆菌对所有测试药物的耐药率均要显著高于铜绿假单胞菌。结论通过与全国耐药监测数据比对,该实验室数据大部分与全国数据相符合,可以为临床合理应用抗菌药物提供帮助及依据。

Objective To understand the distribution and antibiotic resistance profile of clinical isolates in the Affiliated Hospital of Youjiang Medical University during 2015. Methods The pathogenic microorganisms were isolated from inpatients from January to December, 2015 in the Affiliated Hospital of Youjiang Medical University. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or VITEK 2-Compact systems. The results were interpreted according to CLSL breakpoints released in 2014, and analyzed by WHONET 5.6 software. Results A total of 4 004 strains of bacteria were collected, including 1 146 （28.6%） strains of gram-positive bacteria, and 2 858 （71.4%） strains of gram-negative organisms. The prevalence of MRSA and MRCNS was 25.8 % and 79.4 %, respectively. MRSA and MRCNS strains were significantly more resistant to most antibiotics than MSSA and MSCNS except trimethoprim-sulfamethoxazole. Most of the S. pneumoniae isolates were from non-meningitis patients, showing high resistance rate to macrolides and tetracycline, but very low resistance rate to quinolones. Enterococcus isolates were mainly E. faecium and E. faecalis. More E. faecium were resistant to high-level gentamicinand high-level streptomycin than E. faecalis. E. faecium isolates were generally more resistant than E. faecalis to most of the antimicrobial agents tested except clindamycin and tetracyclines. But no gram-positive cocci were found resistant to vancomycin, linezolid or tigecycline. ESBLs-producing strains accounted for 53.1% of the E. coli strains and 28.5% of K. pneumoniae isolates. Enterobacteriaceae isolates were still very susceptible to carbapenems. E. coli isolates were more resistant to most of the antimicrobial agents tested than other Enterobacteriaceae except to piperacillin-tazobactam and carbapenems. Enterobacteriaceae showed higher resistance to trimethoprim-sulfamethoxazole than the other antibiotics tested. Majority of P. aeruginosa isolates were susceptible to all the antibiotics tested （〈10 % resistant）. A. baumannii strains showed significantly higher resistance rate than P. aeruginosa to all the antibiotics tested. Conclusions Most of the data in this report are consistent with the national data in terms of antimicrobial resistance profile. These data are useful for rational use of antibiotics.