2014-2016年北京某三甲医院临床分离菌的耐药性监测

Surveillance of antimicrobial resistance in clinical isolates from a tertiary hospital in Beijing during 2014-2016

目的了解2014-2016年北京积水潭医院常见临床分离菌的分布及耐药情况,为临床合理选用抗菌药物提供依据。方法回顾性分析该院各类临床标本分离菌的分布及耐药性数据,依据CLSI 2016年标准判断结果,应用BD Epicenter进行统计。结果 3年共检出6 881株细菌,其中革兰阳性球菌2 509株,占36.5%;革兰阴性杆菌4 372株,占63.5%。前5位的细菌依次为金黄色葡萄球菌(14.0%)、铜绿假单胞菌(9.8%)、大肠埃希菌(8.9%)、肺炎克雷伯菌(7.9%)和鲍曼不动杆菌(7.3%)。耐甲氧西林金黄色葡萄球菌(MRSA)和表皮葡萄球菌(MRSE)的检出率分别占各自菌的44.3%和72.0%,未见万古霉素和利奈唑胺耐药株。屎肠球菌中耐万古霉素菌株的检出率为11.8%,未见耐万古霉素的粪肠球菌。大肠埃希菌和肺炎克雷伯菌中产超广谱β内酰胺酶(ESBL)的检出率分别为47.6%和23.9%。肠杆菌科细菌对阿米卡星、阿莫西林-克拉维酸、哌拉西林-他唑巴坦的敏感率接近或高于80%。肠杆菌科细菌对碳青霉烯类最敏感,仅检出1株耐碳青霉烯类肺炎克雷伯菌。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为15.8%~26.1%和13.5%~24.5%,且呈逐年上升趋势。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率无明显变化,分别在49.2%~63.1%和48.2%~60.4%。嗜麦芽窄食单胞菌对左氧氟沙星和氯霉素的耐药率均小于30%。结论 3年间该院临床分离菌以金黄色葡萄球菌为首位,其次为铜绿假单胞菌和大肠埃希菌,病原菌对常见抗菌药物有不同程度的耐药,应根据药敏结果合理选择抗菌药物,减少耐药菌株的出现。

Objective To investigate the distribution and antimicrobial resistance of the clinical isolates from Beijing Ji Shui Tan Hospital during 2014-2016 and provide reference for rational use of antimicrobial agents.Methods A retrospective analysis was conducted with the bacterial strains isolated from various clinical specimens and the antimicrobial resistance data in our hospital.The data were analyzed with BD Epicenter software according to the breakpoints of the American Association of Clinical Laboratory Standardization Institute 2016.Results A total of 6 881 strains were isolated,of which gram positive cocci and gram negative bacilli accounted for 36.5%and 63.5%,respectively.The top 5 most frequently isolated microorganisms were Staphylococcus aureus(14.0%),Pseudomonas aeruginosa(9.8%),Escherichia coli(8.9%),Klebsiella pneumoniae(7.9%),and Acinetobacter baumannii(7.3%).The prevalence of methicillin-resistant isolates was 44.3%in Staphylococcus aureus and 72.0%in Staphylococcus epidermiss.All staphylococcal strains were susceptible to vancomycin and linezolid.The prevalence of vancomycin-resistant Enterococcus was 11.8%in Enterococcus faecium.All the Enterococcus faecalis isolates were susceptible to vancomycin.The prevalence of extended spectrum beta-lactamase(ESBL)positive strains was 47.6%in E.coli and 23.9%in K.pneumoniae.The susceptibility rates of the Enterobacteriaceae strains to amikacin,amoxicillin-clavulanic acid and piperacillin-tazobactam were close to or higher than 80%.The Enterobacteriaceae strains were highly sensitive to carbapenems.Only 1 carbapenem-resistant strain was identified in K.pneumoniae.The prevalence of imipenemresistant and meropenem-resistant strain was 15.8%-26.1%and 13.5%-24.5%in P.aeruginosa.The prevalence of imipenem-resistant and meropenem-resistant strain was 49.2%-63.1%and 48.2%-60.4%in A.baumannii.The resistance rates of S.maltophilia to levofloxacin and chloramphenicol were lower than 30%.Conclusions The most frequently isolated bacteria in 2014-2016 was S.aureus,followed by P.aeruginosa and E.coli.The clinical isolates showed various resistance to common antimicrobial agents.Antibiotics should be prescribed reasonably according to the results of susceptibility testing,so as to reduce bacterial resistance.