2014～2016年黔北地区某医院肠杆菌科细菌临床分布与耐药变迁分析

Analysis of clinical distribution and drug resistance changes of enterobacteriaceae bacteria in a hospital in north of Guizhou from 2014 to 2016

目的了解肠杆菌科细菌临床分布特征与耐药性变迁,为临床抗肠杆菌科细菌感染提供实验数据。方法收集遵义医学院附属医院2014年~2016年从各标本分离的感染菌株,利用VITEK MS质谱仪和全自动微生物鉴定及药敏分析仪进行鉴定与药敏实验。使用WHONET5.6软件对结果进行分析比较。结果 2014~2016年共分离肠杆菌科细菌7 110株,前3位菌属均为埃希菌属、克雷伯菌属、肠杆菌属。主要标本来源是尿液所占比例达27%以上,其次是痰液及血液。2014~2016年产超广谱β-内酰胺酶(Extended Spectrum Beta-Lactamases,ESBLs)大肠埃希菌分别占大肠埃希菌58.1%、61.2%、63.3%,产ESBLs肺炎克雷伯菌分别占肺炎克雷伯菌35.0%、33.1%、29.3%。在药敏分析中,肠杆菌科细菌对青霉素类药物耐药率高,耐药率均高于50%。前3种细菌对阿米卡星与亚胺培南保持着较高的敏感性,耐药率均低于5.0%。结论埃希菌属检出率逐年增加,而克雷伯菌属、肠杆菌属为逐年下降的趋势;产ESBLs大肠埃希菌逐年上升;3种细菌对阿米卡星、碳青霉烯类药物保持着较高的敏感性,但已出现耐药菌,应引起重视。加强对医院感染和对医院抗菌用药的控制,合理使用抗菌药物,降低肠杆菌科细菌耐药率。

Objective To investigate the clinical characteristics of distribution and analyze the changes of drug resistance of Enterobacteriaceae,so as to provide experimental data for clinical resistance of Enterobacteriaceae infection. Methods The pathogens were isolated from various submitted specimens which were obtained from Affiliated Hospital of Zunyi Mdical University from 2014 to 2016. The rapid bacterial identification and drug susceptibility testing were performed by VITEK MS mass spectrometer and automatic microbiological identification and drug sensitivity analyzer. WHONET5. 6 software was used to analyze and compare the results. Results A total of7 110 strains of Enterobacteriaceae were isolated from 2014 to 2016,and the top three were Escherichia,Klebsiella and Enterobacteriaceae,of which more than 27% were isolated from urine specimens,followed by sputum and blood. The ESBLs-producing Escherichia coli accounted for 58. 1%,61. 2% and 63. 3% of Escherichia coli,respectively. The ESBLs-producing Klebsiella pneumoniae accounted for 35. 0%,33. 1% and 29. 3% of Klebsiella pneumoniae,respectively. In the drug sensitivity analysis,the drug resistance rate of Enterobacteriaceae to penicillins was high more than 50%. The top three kinds of bacteria maintained high sensitivities on the amikacin and imipenem,and the resistance rates were lower than 5. 0%. Conclusion The detection rate of Escherichia was increasing year by year,while Klebsiella and Enterobacter were decreasing. The production of ESBLs Escherichia coli increased year by year. The top three kinds of bacteria maintained high sensitivities on amikacin and carbapenem drugs. But there have been resistant bacteria,so we should pay attention. Strengthening the control of hospital infection and the rational use of hospital anti-bacterial drug could reduce the resistance rate of Enterobacteriaceae.