某院2013～2015年细菌耐药性监测结果分析

Analysis of Bacterial Resistance in a Hospital during 2013 and 2015

目的:分析2013~2015年某院临床分离菌的分布和耐药特征,为医院感染防控和抗菌药物合理使用提供参考依据。方法:采用微生物常规检测方法对分离菌株进行药敏试验,通过生物梅里埃ATB 1.22软件对药物敏感实验进行分析。根据CLSI 2014年标准判定药敏结果。结果:2013~2015年送检标本数为18 421份,从中分离出各种病原菌共3 744株,总阳性率为20.32%。分离鉴定前5位的致病菌分别为大肠埃希菌(967株,44.34%)、鲍曼不动杆菌(323株,14.81%)、肺炎克雷伯菌(312株,14.31%)、金黄色葡萄球菌(297株,13.62%)、铜绿假单胞菌(282株,12.92%)。除肺炎克雷伯菌对阿莫西林天然耐药外,大肠埃希菌对哌拉西林耐药率超过75%,肺炎克雷伯菌对哌拉西林/他唑巴坦敏感率则维持在90%以上。鲍曼不动杆菌、铜绿假单胞菌对临床常用抗菌药物敏感性基本维持在40%以下,整体耐药水平较高。MRSA对呋喃妥因、米诺环素、奎奴普汀–达福普汀以及糖肽类药物(如替考拉宁、万古霉素)敏感。结论:医院应加强细菌耐药监测,并对结果进行及时追踪,为临床合理选择用药提供参考依据。

Objective： To analyze the distribution and drug resistance characteristics of clinical separation germ in a hospital from 2013 to 2015 to provide reference and basis for the prevention and control of nosocomial infection and rational use of antibiotics. Meth- ods： The microbial susceptibility of isolated strains was detected using the conventional methods, and the drug sensitivity was analyzed by BioMerieux ATB 1.22. The drug sensitivity was determined according to CLSI 2014 criteria. Results： A total of 18 421 specimens were isolated during 2013 and 2015, and a total of 3 744 strains were isolated with the total positive rate of 20.32%. The separation and identification of pathogenic bacteria at the top 5 were Escherichia coli （967 strains, 44.34% ）, Bauman Acinetobacter （323 strains, 14.81% ）, KlebsieUa pneumoniae （312 strains, 14.31% ）, Staphylococcus aureus （297 strains 13.62% ） and Pseudomonaz aeruginosa （282 strains, 12.92% ）. Besides the natural resistance of Klebsiella pneumoniae to amoxicillin, the resistance rate of Esch- erichia coli to piperacillin was over 75%, while the sensitivity rate of Klebsiella pneumoniae to piperacillin and tazobactam was more than 90%. The sensitivity ofAcinetobacter baumannii and Pseudomonas aeruginosa to clinical antibiotics was basically below 40%, and the overall resistance level was higher than that of Bauman. MRSA was sensitive to nitrofurantoin, minocycline, quinupristin-Dafoe and leptin glycopeptide antibiotics （such as teicoplanin and vancomycin）. Conclusion： The hospital should strengthen the monitoring of bacterial resistance and track the results in a timely manner so as to provide reference for the rational drug use in clinical practice.