2016年东莞东华医院细菌耐药性监测

Surveillance of antimicrobial resistance in Dongguan Tungwah Hospital during 2016

目的了解2016年东莞东华医院细菌耐药性监测结果。方法采用纸片扩散法或自动化仪器法对东莞东华医院临床分离菌进行药敏试验,参照2016版CLSI标准判定药敏结果,并用WHONET5.6软件统计分析。结果 3 482株临床分离菌中革兰阳性菌1 199株,占34.4%;革兰阴性菌2 283株,占65.6%。甲氧西林耐药金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)在各自菌种中的检出率分别为28.7%(86/300)和77.7%(300/386)。葡萄球菌属中未发现万古霉素和利奈唑胺耐药株。仪器法检出1株屎肠球菌耐万古霉素,用万古霉素E试验条复核。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)中ESBL的检出率分别为59.6%(337/565)和29.8%(115/386)。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,对亚胺培南和美罗培南的总耐药率分别为0.4%和0.2%。不动杆菌属对亚胺培南和美罗培南的耐药率分别为38.3%和36.9%。结论定期进行细菌耐药性监测有助于了解医院细菌耐药性变迁,为临床经验用药提供依据,对加强抗菌药物合理应用的监督和管理起到积极作用,同时细菌耐药性需引起高度重视,避免耐药株的广泛传播。

Objective To investigate the antimicrobial resistance profile of clinical isolates in Dongguan Tungwah Hospital during 2016. Methods Antimicrobial susceptibility testing was carried out for the clinical isolates collected from Dongguan Tungwah Hospital according to a unified protocol using Kirby-Bauer method or automated systems. Result were analyzed according to CLSI 2016 breakpoints. Results Of the 3 482 clinical isolates, gram positive cocci and gram negative bacilli accounted for 34.4%（1 199/3 482） and 65.6%（2 283/3 482）, respectively. The prevalence of methicillin-resistant strains was in 28.7%（86/300） in S. aureusand 77.7%（300/386） in coagulase-negative Staphylococcus isolates. No staphylococcal strains were found resistant to vancomycin or linezolid. Overall, one E. faecium strain was identified as resistant to vancomycin by instrument method and confirmed by vancomycin E test. The prevalence of ESBLs-producing strains was 59.6%（337/565） in E. coli and 29.8%（115/386） in Klebsiella spp.（K. pneumoniae and K. oxytoca）. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, 0.4% and 0.2% of the Enterobacteriaceae strains were resistant to imipenem and meropenem, respectively. About 38.3% and 36.9% of Acinetobacter strains were resistant to imipenem and meropenem, respectively. Conclusions Surveillance of antimicrobial resistance is most important and valuable for understanding the changing resistant pattern in local hospital and rational selection of antimicrobial agents. More attention should be paid to surveillance of antimicrobial resistance to avoid the spread of drug resistant strains.