2017年安徽医科大学第一附属医院细菌耐药性监测

Surveillance of antibiotic resistance in clinical isolates from the First Affiliated Hospital of Anhui Medical University during 2017

目的了解安徽医科大学第一附属医院2017年临床分离菌株的构成,分析常用抗菌药物的耐药性和敏感性。方法采用自动化仪器法或纸片扩散法进行抗菌药物的敏感性试验,按照2017年临床和实验室标准化协会(CLSI)标准判读药敏结果,使用WHONET 5.6软件进行统计分析。结果 2017年共检出6495株临床分离株,其中革兰阳性菌1727株,占26.6%;革兰阴性菌4768株,占73.4%。大肠埃希菌检出率最高,占19.8%,其次是肺炎克雷伯菌和鲍曼不动杆菌。菌株主要来自于呼吸道标本和尿液标本,分别占37.0%和23.1%。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)的检出率分别为50.1%和82.1%,尚未检出对万古霉素和利奈唑胺耐药的葡萄球菌。肠球菌属中粪肠球菌和屎肠球菌分别占49.9%和40.4%,检出少数万古霉素耐药的肠球菌。大肠埃希菌、克雷伯菌属以及奇异变形杆菌中产ESBL菌株的检出率分别为57.6%、27.1%和33.0%。肠杆菌科细菌对碳青霉烯类抗生素仍然有较高的敏感率。肺炎克雷伯菌对亚胺培南和美罗培南的耐药率与2016年相比明显升高,铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类抗生素的耐药率稍有下降。结论细菌耐药性形势已十分严峻,给临床抗感染治疗带来巨大挑战,应加强抗菌药物的合理使用和感控措施。

Objective To investigate the antibiotic resistance of clinical isolates in the First Affiliated Hospital of Anhui Medical University during 2017.Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using automated system or Kirby-Bauer method.Results were interpreted according to the breakpoints of CLSI 2017.The data were analyzed by WHONET 5.6 software.Results A total of 6 495 non-duplicate clinical isolates were collected in 2017.There were 1 727 strains(26.6%)of gram-positive bacteria and 4 768 strains(73.4%)of gram-negative bacteria.The most frequently isolated microorganisms were E.coli(19.8%),followed by Klebsiella pneumoniae and Acinetobacter baumannii.The strains were mainly isolated from respiratory tract(37.0%)and urine(23.1%).The prevalence of MRSA and MRCNS in Staphylococcus aureus and coagulase-negative Staphylococcus was 50.1%and 82.1%,respectively.No Staphylococcus strains were found resistant to vancomycin or linezolid.E.faecalis and E.faecium accounted for 49.9%and 40.4%of total Enterococcus isolates.The prevalence of ESBLs-producing strains was 57.6%in E.coli,27.1%in Klebsiella spp.and 33.0%in Proteus mirabilis.Enterobacteriaceae strains were still highly susceptible to carbapenems antibiotics.The Klebsiella pneumoniae isolates in 2017 showed significantly higher resistance rate to imipenem and meropenem than the strains in 2016.However,Pseudomonas aeruginosa and Acinetobacter baumannii strains showed lower resistance rates to carbapenems than the strains in 2016.Conclusions The bacterial isolates in 2017 pose serious threat to clinical antibiotic therapy.More attention should be paid to rational use of antimicrobial agents and infection control measures.