2017年河南省人民医院细菌耐药性监测

Surveillance of antibiotic resistance in the bacterial strains isolated from Henan Provincial People's Hospital in 2017

目的了解河南省人民医院临床分离菌的分布及耐药性。方法收集该院2017年临床分离菌,采用纸片扩散法和自动化仪器法按统一方案进行细菌药物敏感性试验,按美国临床和实验室标准化协会(CLSI)2017年标准判断结果。结果共分离临床病原菌7771株,其中革兰阳性菌2027株,占26.1%;革兰阴性菌5744株,占73.9%。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的检出率分别为51.9%和81.0%;未发现对万古霉素和替考拉宁耐药菌株,血液标本中发现1株耐利奈唑胺的科氏葡萄球菌。肠球菌属中分别检出1株耐万古霉素屎肠球菌和1株耐利奈唑胺粪肠球菌。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌中的产超广谱β内酰胺酶(ESBL)株分别为64.4%、56.2%和34.4%。肠杆菌科细菌,除肺炎克雷伯菌对碳青霉烯类抗生素耐药率为46.7%外,对碳青霉烯类抗生素仍高度敏感,绝大多数菌株的耐药率低于13.0%。结论该院碳青霉烯类耐药肺炎克雷伯菌比例较高,应进行流行病学调查并进一步采取更加有效的感控措施,控制耐药株的医院广泛传播。

Objective To investigate the distribution and antibiotic resistance profile of clinical isolates in Henan Provincial People's Hospital during 2017. Methods Clinical isolates were collected from Henan Provincial People's Hospital during 2017. Antimicrobial susceptibility test was carried out according to a unified protocol using Kirby-Bauer method and automated systems. Results were analyzed according to CLSI 2017 breakpoints. Results A total of 7 771 clinical isolates were collected during 2017, of which gram positive cocci and gram negative organisms accounted for 26.1%(2 027/7 771) and 73.9%(5 744/7 771), respectively. The prevalence of methicillin-resistant isolates in Staphylococcus aureus (MRSA) and coagulase-negative Staphylococcus (MRCNS) was 51.9% and 81.0%, respectively. All staphylococcal isolates were susceptible to vancomycin and teicoplanin. One strain of S. cohnii isolated from blood sample was found resistant to linezolid. One strain of vancomycin-resistant E. faecium and one strain of linezolidresistant E. faecalis were identified. The prevalence of ESBLs-producing strains was 64.4% in E. coli and 56.2% in Klebsiella (K. pneumoniae and K. oxytoca) and 34.4% in Proteus mirabilis isolates. The Enterobacteriaceae strains (except K. pneumoniae) were still highly susceptible to carbapenems. Overall, less than 13.0% of these strains were resistant to carbapenems, while 46.7% of K. pneumoniae isolates were resistant to carbapenems. Conclusions Carbapenem-resistant K. pneumoniae is still highly prevalent in this hospital. Epidemiological survey and infection control measures should be further strengthened to prevent the spread of such drug-resistant strains.