2016年福建省晋江市医院细菌耐药性监测

Surveillance of bacterial resistance in Fujian Jinjiang Municipal Hospital in 2016

目的了解福建省晋江市医院2016年临床分离菌对常用抗菌药物的敏感性和耐药性。方法收集本院2016年1—12月的临床分离菌株,采用自动化仪器法或纸片扩散法(K-B法)进行细菌药物敏感性试验,按美国临床实验室标准化研究协会(CLSI)2016年版标准判断结果,WHONET 5.6软件统计分析。结果共分离临床菌1,744株,其中革兰阳性菌590株,占33.8%,革兰阴性菌1,154株,占66.2%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)检出率分别为29.6%和72.9%,MRSA和MRCNS对常用抗菌药物的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS),未发现替考拉宁、万古霉素和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物(利奈唑胺除外)的耐药率均显著低于屎肠球菌,发现利奈唑胺耐药粪肠球菌2株,未发现替考拉宁和万古霉素耐药的粪肠球菌和屎肠球菌。肺炎链球菌非脑膜炎分离株对青霉素均高度敏感。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)、奇异变形菌中ESBLs检出率分别为50.4%、22.5%和16.7%,肠杆菌科细菌对碳青霉烯类抗生素高度敏感,但有2.8%的肺炎克雷伯菌对碳青霉烯类耐药。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为29.7%和21.2%。不动杆菌属(鲍曼不动杆菌占94.2%)对亚胺培南和美罗培南的耐药率分别为60.5%和62.9%。流感嗜血菌和卡他莫拉菌β-内酰胺酶产酶率分别为46.9%和99.3%。结论县级医院临床分离菌的构成和耐药性均有别于大型综合性医院。

Objective To investigate the distribution and antimicrobial resistance of clinical isolates collected from Fujian Jijiang Municipal Hospital in 2016. Methods Clinical isolates were collected from January to December 2016, and antimicrobial susceptibility testing was carried out by using automated systems or the Kirby-Bauer method. Results were analyzed according to CLSI 2016 by the WHONET5.6. Results A total of 1,744 clinical isolates were collected, of which Gram-positive cocci and Gram-negative organisms accounted for 33.8% （590/1,744） and 66.2% （1,154/1,744）, respectively. Methicillin-resistant Staphylococcus aureus （MRSA） and methicillin-resistant coagulase negative Staphylococcus （MRCNS） accounted for 29.6% and 72.9%, respectively. The resistance rates of methicillin-resistant （MR） strains to most antimicrobial agents were much higher than those of methicillin-susceptible （MS） strains. No staphylococcal strains were found resistant to teicoplanin and vancomycinor linezolid. In Enterococcus spp., the resistance rates of E. faecalis strains to most of the antibiotics tested （except linezolid） were much lower than those of E. faecium. Two strains of E. faecalis were resistant to linezolid. No E. faecalis or E. faecium strains were found resistant to teicoplanin or vancomycin. The non-meningitis S. pneumoniae strains kept high sensibility to penicillin G. The prevalence of ESBLs producing strains was 50.4% in E. coli and 22.5% in Klebsiella spp. （K. pneumoniae and K. oxytoca） and 16.7% in Proteus mirabilis isolates. The strains of Enterobacteriaceae were highly susceptible to carbapenems. However, 2.8% ofK. pneumoniae were resistant to carbapenems. About 29.7% and 21.2% ofP. aeruginosa strains were resistant to imipenem and meropenem. About 60.5% and 62.9% of Acinetobacter spp. （A. baumannii accounts for 94.2%） strains were resistant to imipenem and meropenem, respectively. The prevalence of β-1actamase producing strains was 46.9% in H. influenzae and 99.3% in M. catarrhalis isolates. Conclusion The distribution and antimicrobial resistance of clinical isolates in country hospitals are different from general hospitals.