2015-2016年河北医科大学第二医院细菌耐药性监测

Surveillance of bacterial resistance in the Second Hospital of Hebei Medical University from 2015 to 2016

目的了解2015-2016年河北医科大学第二医院临床分离病原菌耐药情况。方法共收集16 292株非重复临床分离菌,采用VITEK 2-Compact进行细菌鉴定,采用自动化仪器法结合纸片扩散法进行药敏试验,使用WHONET 5.6软件进行数据统计分析。结果 2015、2016年分别收集临床分离菌7 961株、8 331株,革兰阴性菌分别占62.0%、66.9%。2年分离前5位的细菌是肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌和金黄色葡萄球菌,2016年肺炎克雷伯菌分离率上升至第1位(16.1%),血标本凝固酶阴性葡萄球菌分离率由2015年42.6%降至30.0%,葡萄球菌中未发现万古霉素耐药株。2年耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为56.2%、51.3%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)为79.3%、63.1%。911株肠球菌属细菌中粪肠球菌和屎肠球菌分别占25.2%和73.2%。2年屎肠球菌对万古霉素耐药率分别为3.1%、2.9%,2016年肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌对碳青霉烯类耐药率持续上升,肺炎克雷伯菌对除庆大霉素、阿米卡星外所有选择抗菌药物耐药率均呈现上升趋势,对亚胺培南、美罗培南耐药率分别由2015年19.3%、18.5%上升至2016年24.2%、23.1%。2年间鲍曼不动杆菌对常规选择抗菌药物依然维持较高的耐药性,除多黏菌素B、替加环素、头孢哌酮-舒巴坦、米诺环素外,对其他受试抗菌药物耐药率均高于50%。铜绿假单胞菌对阿米卡星、头孢哌酮-舒巴坦,哌拉西林-他唑巴坦、头孢他啶、头孢吡肟耐药率相对较低,分别为11.7%、15.5%、18.7%、20.1%、21.9%。2年间铜绿假单胞菌除对氨曲南耐药率由2015年27.0%上升到2016年34.7%外,对其他抗菌药物耐药率均出现了下降趋势。结论细菌对抗菌药物的耐药性在不断变化,需采取有效的医院感染防控措施,进一步规范控制抗菌药物使用。

Objective To investigate the antibiotic resistance in clinical isolates in the Second Hospital of Hebei Medical University from 2015 to 2016. Methods A total of 16 292 strains of non-duplicate bacterial strains were collected. The isolates were subjected to identification and antimicrobial susceptibility testing on VITEK 2-Compact system. The data were processed and analyzed using WHONET 5.6 software. Results Specifically, 7 961 and 8 331 strains of pathogens were collected in 2015, 2016, respectively. Gram-negative bacteria accounted for 62.0% in 2015 and 66.9% in 2016, respectively. The top five pathogens isolated in these two years were still Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus. The proportion of K. pneumoniae increased to the first place in 2016 which accounted for 16.1%. Coagulase negative Staphylococcus in blood samples decreased from 42.6% in 2015 to 30.0% in 2016. Vancomycin resistant strains were not found in Staphylococcus. In 2015 and 2016, the prevalence of methicillin-resistant Staphylococcus aureus(MRSA) was 56.2% and 51.3%, respectively. The prevalence of methicillinresistant coagulase negative Staphylococcus(MRCNS) was 79.3% and 63.1%, respectively. Enterococcus faecalis and Enterococcus faecium accounted for 25.2% and 73.2% respectively in the 911 strains of Enterococcus. In 2015 and 2016, 3.1% and 2.9% of the E. faecium strains were resistant to vancomycin, respectively. In 2016, the prevalence of carbapenemresistant strains increased in K. pneumoniae, E. coli and E. cloacae. K. pneumoniae showed increasing resistance rate to all the antimicrobial agents tested except for gentamicin and amikacin. The percentage of the K. pneumoniae strains resistant to imipenem and meropenem increased from 19.3%, 18.5% in 2015 to 24.2%, 23.1%, respectively. A. baumannii isolates were still highly resistant to the commonly used antibiotics in these two years, but relatively susceptible to polymyxin B, tigecycline, cefoperazone-sulbactam and minocycline(<30% resistant). P. aeruginosa isolates showed lower resistance rate to amikacin(11.7%), cefoperazonesulbactam(15.5%), piperacillin-tazobactam(18.7%), ceftazidime(20.1%), cefepime(21.9%). P. aeruginosa presented a trend of declining resistance to all the antimicrobial agents tested from 2015 to 2016, except aztreonam, to which the resistant P. aeruginosastrains increased from 27.0% in 2015 to 34.7% in 2016. Conclusions The antimicrobial susceptibility profile of clinical bacterial isolates has been changing constantly. We need to adopt effective infection prevention and control measures in hospital and further standardize and control the use of antibacterial agents.