四川大学华西医院2006年–2015年肠杆菌科细菌分布及耐药特点分析

Drug resistance surveillance of Enterobacteriaceae in West China Hospital of Sichuan University from 2006 to 2015

目的分析四川大学华西医院肠杆菌科细菌分布及耐药性特点,为临床提供长期的监测数据依据。方法收集2006年—2015年临床住院和门诊分离的肠杆菌科细菌非重复菌株,采用法国生物梅里埃公司生产的VITEK-2 Compact全自动微生物鉴定分析仪做鉴定和药物敏感性试验,用WHONET 5.6软件和i Lab Datafor MDR 1.03软件进行统计。结果 2006年—2015年共计分离出肠杆菌科细菌38 487株,其中埃希菌属(14 862株,38.6%)、克雷伯菌属(12 894株,33.5%)、肠杆菌属(6 277株,16.3%)、变形杆菌属(1 758株,4.6%)、沙雷菌属(1 257株,3.3%)、枸橼酸杆菌属(933株,2.4%)和摩根菌属(506株,1.3%)居前7位。分离肠杆菌科细菌的标本分布来源前3位为痰液(46.9%)、尿液(18.7%)和分泌物(11.5%)。肠杆菌科细菌对多数抗菌药物耐药率呈下降趋势,其中氨苄西林、氨苄西林/舒巴坦、头孢唑啉呈高耐药性,耐药率分别为85.3%、52.6%、72.9%。头孢曲松、头孢吡肟、庆大霉素、妥布霉素耐药率明显降低,其余抗菌药物均呈现耐药率降低或低速增长趋势。该院埃希菌属产超广谱β-内酰胺酶(extended-spectrumβ-lactamases,ESBL)菌株分离率变化不大,克雷伯菌属产ESBL菌株分离率下降明显,多重耐药菌(multidrug-resistant organism,MDRO)分离率呈缓慢下降趋势。结论该院抗菌药物总体耐药呈现下降趋势,MDRO、产ESBL菌均呈现下降趋势,但耐碳青霉烯类抗菌药物肠杆菌科细菌持续增长,需要重点关注。长期持续监测细菌的耐药情况对细菌耐药变迁和抗菌药物管理政策制定十分重要。

ObjectiveTo analyze the distribution and drug resistance of Enterobacteriaceae in West China Hospital of Sichuan University, to provide long-term monitoring data references for clinical practice.MethodsThe clinical information of non-repetitive Enterobacteriaceae isolates from 2006 to 2015 was collected and analyzed. All the isolates were identified by VITEK-2 Compact Automatic Microbial Identification Analyzer （Bio Merieux, France）. The statistic informations were analyzed by WHONET 5.6 and iLabDataforMDR 1.03.ResultsA total of 38 487 strains of Enterobacteriaceae were isolated from 2006 to 2015, mainly including 14 862 stains of Escherichia （38.6%）, 12 894 stains of Klebsiella （33.5%）, 6 277 stains of Enterobacter （16.3%）, 1 758 stains of Proteus （4.6%）, 1 257 stains of Serratia （3.3%）, 933 stains of Citrobacter （2.4%）, and 506 stains of Morganella （1.3%）. The top three sample types were sputum （46.9%）, urine （18.7%）, and secretions （11.5%）. The drug resistance rate of Enterobacteriaceae showed a downward trend to most antibacterials. The average resistance rate of Enterobacteriaceae to ampicillin, ampicillin/sulbactam, and cefazolin was 85.3%, 52.6%, and 72.9%, respectively. The resistance rates to ceftriaxone, cefepime, gentamicin, and tobramycin were significantly reduced. The resistance rates to other antibiotics showed decreasing or slow increasing trends. The isolation rate of extended-spectrum β-lactamases （ESBL）-producing strains in Escherichia did not change, but the rate in Klebsiella decreased significantly. The isolation rate of multidrug-resistant organisms （MDRO） showed a slow decrease.ConclusionsThe overall antimicrobial resistance and the isolation rates of MDRO and ESBL-producing organisms showed a downward trend in investigating period. However, the carbapenem-resistant Enterobacteriaceae was rising continuously. Long-term monitoring of drug resistance is of notable value to antibiotic management policies.