宁夏细菌耐药监测网2015年细菌耐药监测数据分析

Ningxia Antimicrobial Resistant Investigation Net 2015 annual report on bacterial drug resistance surveillance in Ningxia

目的对宁夏细菌耐药监测网成员单位2015年度临床分离细菌分布及耐药情况进行统计分析,为本省临床合理使用抗菌药物提供理论依据。方法各成员单位临床分离菌株,采用标准纸片扩散法或自动化仪器检测法,按照统一技术方案测定监测药物对细菌的敏感性,依据CLSI 2014年标准,用WHONET 5.6软件进行数据分析。结果共有30家医院参加了2015年度细菌耐药监测工作,其中数据基本合格纳入分析的共20家。按患者首次分离菌株进行统计分析,共收集细菌25234株,其中革兰阴性菌18412株(72.97%),革兰阳性菌6822株(27.03%)。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(MRCNS)的检出率分别为38.6%和77.3%,未发现万古霉素和利奈唑胺不敏感的葡萄球菌。万古霉素耐药粪肠球菌和屎肠球菌分别为1.7%和1.2%。按非颅内感染的折点判断,耐青霉素肺炎链球菌比例为8%。革兰阴性菌中分离率前3位分别为大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌,分别为5469株(21.67%)、4609株(18.26%)和1843株(7.3%)。大肠埃希菌耐药比较突出,对喹诺酮类耐药率在50.0%以上,肠杆菌科细菌对碳青霉烯类抗菌药物总耐药率低于10.0%。铜绿假单胞菌对碳青霉烯类、氨基糖苷类、哌拉西林/三唑巴坦、头孢吡肟、头孢哌酮/舒巴坦和头孢他啶的耐药率低于15.0%,鲍曼不动杆菌对包括碳青霉烯类在内的大多数监测药物耐药率超过50.0%,亚胺培南的耐药率为65%。结论我省细菌耐药整体较全国水平较低,但多重耐药和广泛耐药菌株检出仍对临床治疗造成严重威胁,应充分利用本地细菌耐药监测结果进行感控管理,促进抗菌药物合理使用。

Objective To explore the bacterial drug resistance and its epidemic tendency in 2015 from members of Antimicrobial Resistant Investigation Net of Ningxia, and to guide the rational use of antimicrobial drugs. Methods All the bacterial isolates were collected and identified by a unified protocol, and then the susceptibility data detected with the method of disc-diffusion or automatic clinical microbiological systems were analyzed by software WHONET 5.6. Results 25,234 bacterial isolates and their antibacterial susceptibility data were collected from all the 20 members of Antimicrobial Resistant Investigation Net, including 18412 （72.97%） Gram-negative bacterial isolates and 6,822 （27.03%） Gram-positive bacterial isolates. The isolating rates of methicillin-resistant Staphylococcus aureus （MRSA） and methicillin-resistant coagulase negative Staphylococcus （MRCNS） were 38.6% and 77.3%. No vancomycin and linezolid non-sensitive Staphylococcus isolates were found. There were 1.7% E. faecalis and 1.2% E. faecium resistant to vancomycin. According to non-CNS, 8% penicillin-resistant Streptococcus pneumoniae were found. The top three populations of Gram-negative bacterial isolates were E. coli （5469 isolates, 21.67%）, K. pneumoniae （4,609 isolates, 18.26%）, and A. baumannii （1,843 isolates, 7.3%）, respectively. The most outstanding resistance rates of Gram-negative bacterial isolates was E. coli whose resistance rate to quinolones was above 50.0%. Even the total carbapenem-resistance rate of the Enterobacteriaceae was below 10.0%. The susceptible rates of P. aeruginosa to carbapenem, aminoglycosides, piperacillin/tazobactam, cefepime, cefoperazone/sulbactam, and ceftazidime were all below 15.0%. The resistance rates of A. baumannii to most surveillance drugs including carbapenem were above 50.0%, and imipenem was 65%. Conclusion Although bacterial drug resistance in our province compared with the national level is low, we also should fully use bacterial drug resistance surveillance results for supervision and administration, and take effective measures for the control of the spread of resistant isolates.