2017年福州市第二医院病原菌的分布及耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria in Fuzhou Second Hospital in 2017

目的了解2017年福州市第二医院临床分离病原菌的分布及对抗菌药物的敏感性,为临床用药提供指导。方法共收集2 720株非重复分离菌,采用纸片扩散法或自动化仪器法进行药敏试验,按CLSI标准判读药敏结果。结果 2 720株细菌中,标本主要来源于伤口分泌物(989株),占36.3%。革兰阴性菌1 786株,占65.7%,主要为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌和阴沟肠杆菌;革兰阳性菌934株,占34.3%,主要为金黄色葡萄球菌、粪肠球菌和凝固酶阴性葡萄球菌。耐甲氧西林耐药株金黄色葡萄球菌、凝固酶阴性葡萄球菌的检出率分别为42.7%、84.2%。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。粪肠球菌对大多数抗菌药物的耐药率明显低于屎肠球菌。肠球菌属中未发现万古霉素、利奈唑胺、替考拉宁耐药的肠球菌。除对黏菌素100%敏感外,铜绿假单胞菌对其他常见抗菌药物的耐药率均较低,鲍曼不动杆菌除对黏菌素敏感外,对其他药物的耐药性均较高,均达46.2%以上。结论 2017年福州市第二医院病原菌耐药形势依旧严峻,应加强合理用药,避免交叉感染。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in Fuzhou Second Hospital in 2017, and to provide a reference for clinical rational drug use. Methods A total of 2 720 nonduplicate clinical isolates were collected. Kirby-Bauer method and automated systems were employed to study the antimicrobial susceptibility. Antimicrobial susceptibility testing was performed according to CLSI document. Results Total 2 720 strains of pathogens were isolated. The specimens were mainly from wound secretion（989 strains）, accounting for 36.3%. Gram-negative bacteria were 1 786 strains（65.7%）, and main of them were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia and Enterobacter cloacae. Gram-positive bacteria（934 strains） accounted for 34.3%, and main of them were Staphylococcus aureus, Enterococcus faecalis and coagulase-negative Staphylococcus. The detection rate of methicillin-resistant S. aureus and coagulase-negative Staphylococcus were 42.7% and 84.2%, respectively. There was no Staphylococcus resistant against vancomycin, tercoranine, and leinazole. The drug resistance rate of Enterococcus faecalis against most antibacterial agents was lower than that of E. faecium. There was no Enterococcus resistant against vancomycin, linezolid, and teicoplanin. The sensitive rate of P. aeruginosa against colistin was 100%, while the drug resistance rate of P. aeruginosa against other antibacterial agents was low. A. baumannii was sensitive to colistin, while the drug resistance rate of A. baumannii against other antibacterial agents were higher, and were high above 46.2%. Conclusion Bacterial resistance is still serious in Fuzhou Second Hospital in 2017, and it is necessary to strengthen rational drug use to avoid cross infection.