2015年山东省立医院细菌耐药性监测

Surveillance of antibiotic resistance in clinical isolates from Shandong Provincial Hospital during 2015

目的了解山东省立医院2015年临床分离细菌的分布及对常用抗菌药物的耐药性。方法除葡萄球菌属采用VITEK 2Compact测定其药物敏感性外,其余菌株均采用纸片扩散法。判读参照美国临床和实验室标准化协会(CLSI)2015版M100-S25,数据分析采用WHONET5.6软件。结果 2015年共收集非重复临床分离菌4 252株,其中革兰阴性菌2 900株(68.20%),革兰阳性菌1 352株(31.80%)。耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为35.82%和68.75%。屎肠球菌的耐药率高于粪肠球菌,3株万古霉素耐药的肠球菌均为屎肠球菌。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌产超广谱β-内酰胺酶(ESBLs)菌株的比率分别为41.00%、24.71%和37.29%。肠杆菌科细菌中产ESBLs菌株对所测试抗菌药物的耐药率高于非产ESBLs菌株。共分离碳青霉烯类抗菌药物耐药肠杆菌科细菌88株。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为19.7%和17.6%。鲍曼不动杆菌除对头孢哌酮/舒巴坦耐药率为32.3%外,对其他抗菌药物的耐药率均>40%。流感嗜血杆菌中ESBLs的阳性率为65.28%。肺炎链球菌均为非脑膜炎菌株,主要来源于儿科病房(72.62%),儿童分离株中青霉素耐药肺炎链球菌所占比例略高于成人分离株。结论 2015年该院细菌耐药性呈增高趋势,应重视细菌耐药性监测并采取有效的医院感染控制措施和加强抗菌药物的合理使用。

Objective To investigate the resistance and distribution of bacteria of clinical isolates in Shan- dong Provincial Hospital during 2015. Methods Except for antimicrobial susceptibility of staphylococcal strains was tested by VITEK 2 Compact, and the disk diffusion method was used for the other strains. The re- sults were interpreted according to the CLSI 2015 M100-S25,and the data were analyzed by using WHONET 5.6 software. Results A total of 4 252 non-duplicate clinical strains were collected during 2015, of which gram-negative rods and gram-positive cocci accounted for 68. 20% and 31. 80%, respectively. The detection rates of methicillin resistant staphylococcus aureus（MRSA） and methicillin resistant coagulase negative staph- ylococci （MRSCN） were 35.82% and 68.75% ,respectively. The percentage of the E. faecium strains resistant to most antibiotics tested was higher than that of E. faecalis. We found three strains of vancomycin resistant enterococcus were E. faecium. The prevalence of ESBLs were 41.00% in the strains of E. coil and 24.71% in K. pneumoniae strains and 37.29% in Proteus mirabilis strains, respectively. The resistance rate of ESBLs- positive strains was higher than ESBLs-negative strains to most antibiotics. A total of 88 carbapenem-resistant Enterobacteriaceae isolates were identified. The percentage of the P. aeruginosa strains resistant to imipenem and meropenem were 19.7% and 17.6% ,respectively. More than 40% of the A. baumannii strains were resist- ant to all the antibiotics tested except cefoperazone（32.3%）. The prevalence of β-lactamase in H. influenzae was 65.28%. All the S. pneumoniae strains were non-meningitis strains,mainly isolated from children＇s ward （72.62%）. The higher prevalence of penicillin resistant S. pneumoniae was found in the strains isolated form children compared to the isolates from adults. Conclusion Bacterial resistance is on the rise. More attention should be paid to resistance surveillance and rational use of antibiotics.