2016年临床分离菌的分布及耐药性分析

Analysis of bacterial distribution and resistance during 2016

目的了解2016年本单位临床分离菌种分布及对常用抗菌药物的耐药性。方法收集本院所有初次分离的菌株,药敏试验采用纸片扩散法或全自动仪器法检测,E-test法检测肺炎链球菌对青霉素不敏感的最低抑菌浓度(minimal inhibitory concentration,MIC)。采用WHONET 5.6软件进行数据统计分析。结果共分离临床菌株4201株,革兰阳性菌34.8%(1461/4201),革兰阴性菌65.2%(2740/4201)。革兰阳性菌主要为金黄色葡萄球菌11.1%(463/4201),凝固酶阴性葡萄球菌12.1%(507/4201),其中耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin resistant coagulase-negative staphylococci,MRCNS)的检出率为(25.3%和70.2%),未发现万古霉素、替加环素和利奈唑胺耐药株。肠球菌属以粪肠球菌和屎肠球菌为主,屎肠球菌对所检测抗菌药物的耐药率明显高于粪肠球菌,二者未检测出万古霉素和利奈唑胺耐药株。革兰阴性菌位列前5位依次是大肠埃希菌17.7%、克雷伯菌属14.1%、铜绿假单胞菌8.7%、鲍曼不动杆菌7.1%和阴沟肠杆菌2.8%。大肠埃希菌和克雷伯菌属中产超广谱β-内酰胺酶(ESBLs)株的检出率分别占55.7%和25.4%。肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为22.5%、20.6%和61.5%。肠杆菌科细菌中耐替加环素菌株检出率为4.4%。结论临床常见细菌耐药性仍较严重,尤其是肠杆菌科细菌对替加环素以及克雷伯菌对亚胺培南耐药率上升明显,感染控制部门应采取有效防范措施,避免耐药菌株的进一步传播。

Objective To analyze the distribution and resistance of clinical isolated bacteria in our hospital in 2016. Methods All the bacteria strains isolated for the first time were collected for analysis. The drug sensitivity test was carried out by the method of Kirby-Bauer or the automatic instrument. The method of E-test was used to detect the MIC of Streptococcus pneumoniae against penicillin. WHONET 5.6 software was used for the statistic analysis of data. Results A total of 4,201 strains of clinical isolates were isolated, including 34.8% （1,461/4,201） Gram-positive bacteria, 65.2% （2,740/4,201） Gram-negative bacteria. Gram-positive bacteria were mainly Staphylococcus aureus （11.1%, 463/4,201）, coagulase-negative staphylococci （12.1%, 507/4,201）, in which methicillin-resistant strains （MRSA and MRCNS） were detected with rates of 25.3% （117/463） and 70.2% （356/507）. Vancomycin, tigecycline, and linezolid resistant strains were not found. 93 strains of Streptococcus pneumoniae and no meningitis strains were isolated; for Enterococcus, Enterococcus faecalis and Enterococcus faecium were detected, the resistance rate of Enterococcusfaecium to the tested antimicrobials was significantly higher than Enterococcusfaecalis, both of which did not show resistance to vancomycin, tigecycline, and linezolid. For the Gram-negative bacteria in the test, the first five were Escherichia coli （17.7%）, Klebsiella spp. （14.1%）, Pseudomonas aeruginosa(8. 7%), A cinetobacter baumannii （7.1%） and Enterobacter cloacae （2.8%）. The detection rates of generating ESBLs in E. coli and Klebsiella spp.were 55.7% and 25.4% respectively. The resistance rates of K. pneumoniae, P. aeruginosa, and A. baumannii to imipenem were 22.5%, 20.6%, and 61.5%, respectively. The detection rate of bacteria in Enterobacteriaceae resistant to tigecycline was 4.4%. Conclusions Clinical common bacterial resistance is still very serious, and especially the resistance rates of Enterobacteriaceae to tigecycline, Klebsiella spp. to imipenem increased significantly. Infection control departments should take effective preventive measures to avoid the further spread of drug-resistant strains.