2014—2016年某综合医院细菌耐药性监测分析

Surveillance and analysis of bacterial resistance in a general hospital from 2014 to 2016

目的总结2014年1月—2016年12月甘孜藏族自治州人民医院病原菌的分布特点及其耐药性,为合理应用抗菌药物提供参考。方法回顾性分析2014年1月—2016年12月甘孜藏族自治州人民医院各病区采集的病原菌标本,采用VITEK2-compact15全自动微生物鉴定药物敏感性(药敏)分析系统进行细菌鉴定和药敏试验;药敏试验依据美国临床和实验室标准化协会2015年药敏标准(M100-S25版)抗菌药物药敏折点标准分析检测结果,并用WHONET 5.6软件进行数据统计分析。结果 2014年1月—2016年12月共收到临床标本33 516份,分离出细菌2987份,阳性率8.91%。分离的病原菌以革兰阴性杆菌为主,其中大肠埃希菌居首,肺炎克雷伯菌为其次;病原菌主要来于痰液、尿液、脓液、切口分泌物、血液、阴道分泌物、胆汁、耳道分泌物等标本,其中外科、内科、ICU科室标本送检量居前3位;大肠埃希菌对氨苄西林、氨苄西林舒巴坦、头孢曲松、复方磺胺甲噁唑耐药率分别为88.04%、53.30%、50.75%、43.69%;除氨苄西林外,肺炎克雷伯菌对各常见抗菌药物耐药率均<40.00%;大肠埃希菌对氨苄西林、金黄色葡萄球菌对青霉素、鲍曼不动杆菌对头孢替坦、氨曲南、氨苄西林耐药率均≥75.00%;2014—2016年耐甲氧西林金黄色葡萄球菌、耐甲氧西林表皮葡萄球菌检出率呈下降趋势。结论细菌的耐药性日趋严重,尤其是重要病原菌的多药耐药检出率呈增长趋势,临床应及时监测病原菌变化与耐药趋势,并针对不同耐药情况合理选择抗菌药物,并做好多药耐药菌院内的防控工作。

Objective To summarize the distribution characteristics of pathogens and resistance in Ganzi Tibetan Autonomous Prefecture People＇s Hospital from January 2014 to December 2016, and provide reference for the reasonable use of antibacterial drugs. Methods The pathogen specimens collected from the wards of Ganzi Tibetan Autonomous Prefecture People＇s Hospital from January 2014 to December 2016 were analyzed retrospectively. VITEK2-compact15 automatic microbial identification drug susceptibility analysis system was used for bacterial identification and drug susceptibility testing. The drug susceptibility testing results were analyzed according to the antimicrobial drug susceptibility point standard of drug sensitivity standard in 2015 formulated by American Clinical and Laboratory Standardization Association（CLSI M100-S25 version）. WHONET 5.6 software was used for data statistics and analysis. Results A total of 33516 clinical specimens were collected from January 2014 to December 2016, among which 2987 bacteria were isolated with the positive rate of 8.91%. The isolates were mainly gram-negative bacilli, and Escherichia coli was the first followed by Klebsiella pneumoniae. Pathogens mainly came from sputum, urine, pus, incision secretions, blood, vaginal secretions, bile, ear vein secretions and other specimens. The first three departments of the specimens sent to detect were the surgery, internal medicine and ICU. The resistance rates of Escherichia coli towards ampicillin, ampicillin/sulbactam, ceftriaxone and compound sulfamethoxazole were 88.04%, 53.30%, 50.75% and 43.69%, respectively. Except ampicillin, the resistance rates of Klebsiella pneumoniae towards common antibiotics were less than 40%. The resistance rates of Escherichia coli towards ampicillin, Staphylococcus aureus towards penicillin, Acinetobacter baumannii towards cefotetan, aztreonam and ampicillin were no less than 75%. The total detection rates of methicillin resistant staphylococcus aureus and methicillin-resistant staphylococcus epidermidis were decreasing from 2014 to 2016. Conclusions The bacterial resistance becomes more serious, especially the multidrug resistance detection rate of important pathogens is increasing. Therefore, the change of pathogens and drug resistance should be monitored in time. Antibacterial agents should be selected rationally for different drug resistance conditions. The hospital prevention and control work should be done well for multidrug resistant bacteria.