安徽省滁州市儿童医院2014年临床分离菌的耐药性监测

Surveillance of antimicrobial resistance in the clinical isolates from Children's Hospital of Chuzhou during 2014

目的了解滁州市儿童医院2014年常见病原菌的临床分布及耐药情况。方法回顾性分析各类临床标本分离菌的分布及耐药性。结果 2014年共分离细菌382株,其中革兰阳性菌143株,占37.4%;革兰阴性菌239株,占62.6%。居前5位的细菌分别是:大肠埃希菌(18.8%)、肺炎克雷伯菌(16.8%)、凝固酶阴性葡萄球菌(13.1%)、肺炎链球菌(9.4%)和金黄色葡萄球菌(9.2%)。葡萄球菌属中MRSA和MRCNS的检出率分别为28.6%和76.0%。葡萄球菌属中未见达托霉素、利奈唑胺和万古霉素的耐药株。肠球菌属中粪肠球菌和屎肠球菌对达托霉素、利奈唑胺和万古霉素全部敏感。未检出青霉素耐药肺炎链球菌。大肠埃希菌和肺炎克雷伯菌产超广谱β内酰胺酶(ESBL)菌株的检出率分别为58.3%和28.1%。肠杆菌科细菌对碳青霉烯类最敏感,188株肠杆菌科细菌中检出3株碳青霉烯类耐药株,检出率为1.6%。铜绿假单胞菌除对哌拉西林的耐药率为13.3%和对左氧氟沙星的耐药率为6.7%外,对其余所测抗菌药物全部敏感。不动杆菌属对碳青霉烯类的敏感率最高,仅检出1株耐碳青霉烯类鲍曼不动杆菌,检出率为4.3%。结论 2014年该院临床分离菌以革兰阴性菌为主,多重耐药率较高,尤其是碳青霉烯类耐药肠杆菌料细菌的出现,对临床抗感染治疗构成严重威胁,应引起足够重视,加强耐药性监测。

Objective To investigate the distribution and antimicrobial resistance of the clinical isolates from Children＇s Hospital of Chuzhou during 2014. Methods A retrospective analysis was conducted with the bacterial strains isolated from various clinical specimens in 2014. Results A total of 382 clinical isolates were collected during 2014, of which gram positive organisms and gram negative organisms accounted for 37.4 % and 62.6 %, respectively. The top 5 most frequently isolated microorganisms were E. coli （18.8 %）, K. pneumoniae （16.8 %）, coagulase negative Staphylococcus （13.1%）, S. pneumoniae （9.4 %） and S. aureus （9.2 %）. The prevalence of MRSA was 28.6 % in S. aureus and the prevalence of MRCNS was 76 % in CNS. All staphylococcal strains were susceptible to daptomycin, linezolid and vancomycin. All the E. faecalis and E. faecium isolates were sensitive to daptomycin, linezolid and vancomycin. All the S. pneumoniae strains were susceptible to penicillin. The prevalence of extended spectrum- lactamases （ESBLs） positive strains was 58.3 % in E. coli and 28.1% in K. pneumoniae. The Enterobacteriaceae strains were highly sensitive to carbapenems. Only 3 （1.6%） carbapenem-resistant strains were identified in the Enterobacteriaceae isolates. About 13.3 % and 6.7 % of the P.. aeruginosa isolates were resistant to piperacillin and levofloxacin, reslaectively. All the P. aerueinosastrains were sensitive to the other antimicrobial agents. The percentage of carbapenem-resistant Acinetobacter strains was lower than 10%. Only one carbapenem-resistant A. baumannii strain was identified. Conclusions Gram negative microorganisms account for most part of the clinical bacterial isolates in 2014. The antimicrobial resistance is still very serious in this hospital, especially the emergence of carbapenem-resistant Enterobacteriaceae, which is of great concern.