某二甲医院肠杆菌科细菌分布与耐药性分析

Analysis of the distribution and antimicrobial resistance of Enterobacteriaceaein a grade-2A hospital

目的分析某医院肠杆菌科细菌的临床分布及耐药现状,为临床提供耐药预警和用药依据。方法收集2014年1月~2016年12月临床分离的肠杆菌科细菌,使用WHONET 5.6分析其临床分布与耐药率,使用SPSS 17.0分析耐药率与抗菌药物使用强度的Pearson相关性。结果共分离肠杆菌科细菌3 193株,占分离菌的68.93%。分离率排前4位的肠杆菌是大肠埃希菌、肺炎克雷伯菌、产气肠杆菌和聚团肠杆菌。检出率前3位的科室是呼吸科、消化科和神经外科。产超广谱β内酰胺酶在大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌和奇异变形杆菌中检出,在呼吸科、消化科和重症医学科检出率最高;产碳青霉烯酶在聚团肠杆菌等7种菌株中检出,主要分布在重症医学科和神经外科。大肠埃希菌耐药情况较肺炎克雷伯菌严重;最新数据显示,大肠埃希菌对氨苄西林、头孢唑林、头孢哌酮和头孢噻肟的耐药率均>75%,肺炎克雷伯菌对氨苄西林和头孢噻肟的耐药率>75%。常用抗菌药物使用强度与大肠埃希菌和肺炎克雷伯菌耐药率有较复杂的相关性。结论肠杆菌科细菌在该院检出率高、耐药率不断变迁,大肠埃希菌与肺炎克雷伯菌耐药率与抗菌药物使用强度有相关性。医院应加强耐药数据监测,规范抗菌药物使用,延缓耐药进程,提高抗感染疗效。

Objective To investigate the distribution and antimicrobial,resistance of Enterobacteriaceae,to study the correlation between antimicrobial resistance and antibiotics use density（AUD）and to provide the basis for clinical rational use of antibacterial drugs.Methods WHONET 5.6 was employed to analyze the Enterobacteriaceae distribution and antimicrobial resistance from January 2014 to December 2016.SPSS 17.0 was employed to analyze the correlation between antimicrobial resistance and AUD.Results 3 193 Enterobacteriaceae were isolated,among which the top 4 species were E.coli,K.pneumoniae,E.aerogenes and E.agglomerans.Respiratory,gastroenterology,neurosurgery and neurology accounted for the highest propotion.ESBLs producing Enterobacteriaceae were detected in E.coli,K.pneumoniae,K.oxytoca,and P.mirabilis.Respiratory,gastroenterology,and neurology took the highest rate.Pathogens producing carbon,and E.agglomerans was the most frequent,they were detected most in ICU and neurosurgery.Drug resistance rates of E.coli to ampicillin,cefazolin,cefoperazone and cefotaxime exceeded 75%,to K.pneumoniae,ampicilin and cefotaxime exceeded 75%.The correction between AUD and drug resistance of E.coli and K.pneumoniae was frequent.Conclusion The drug resistance of Enterobacteriaceae in the studied hospital is frequent,which may be correlated with AUD.The use of antibacterial agents should be more legitimately basing on the resistance rate so as to delay the bacterial resistance.