2017年鄂尔多斯市中心医院细菌耐药性监测

Surveillance of bacterial resistance in Ordos Central Hospital in 2017

目的了解2017年鄂尔多斯市中心医院临床分离病原菌耐药状况,为临床合理使用抗菌药物和抗感染治疗提供参考依据。方法 2017年共收集2628株临床非重复分离菌,采用VITEK 2-Compact进行细菌鉴定,采用自动化仪器法结合纸片扩散法进行药敏试验。参照2015年CLSI标准判定药敏结果,并用WHONET 5.6软件进行数据统计分析。结果 2017年共收集2628株临床非重复分离菌,其中革兰阴性菌2178株,占82.9%,革兰阳性菌450株,占17.1%。分离前5位的细菌是:大肠埃希菌(19.9%)、肺炎克雷伯菌(16.9%)、铜绿假单胞菌(9.5%)、鲍曼不动杆菌(8.7%)和阴沟肠杆菌(6.6%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为19.7%和61.1%,未发现耐万古霉素葡萄球菌和耐万古霉素肠球菌。大肠埃希菌和肺炎克雷伯菌中产ESBL株分别占47.6%和16.9%,碳青霉烯类耐药肠杆菌科细菌(CRE)14株,占肠杆菌科细菌0.9%。耐亚胺培南铜绿假单胞菌(CRPA)和鲍曼不动杆菌(CRAB)的检出率分别为7.4%和42.8%。结论细菌耐药性,尤其是MRSA、CRE、CRPA和CRAB所致的耐药性不容忽视,应引起重视。加强细菌耐药性监测有助于了解本院细菌耐药性的发生和变迁,并为抗菌药物的合理应用和管理提供科学的参考依据。

Objective To investigate the antibiotic resistance profile of clinical isolates in Ordos Central Hospital during 2017 for rational uses of antimicrobial drugs and clinical anti-infective therapy.Methods A total of 2 628 non-duplicate clinical isolates were collected during 2017.The isolates were subjected to identification on VITEK 2-Compact system.Automated system and Kirby-Bauer method were used to test the susceptibility of these isolates.The results were interpreted according to CLSI 2015 breakpoints.The data were processed and analyzed with WHONET 5.6 software.Results Of the 2 628 strains collected in 2017,gram-negative bacteria accounted for 82.9%(2 178/2 628)and gram-positive bacteria accounted for 17.1%(450/2 628).The top five pathogens were Escherichia coli(19.9%),Klebsiella pneumonia(16.9%),Pseudomonas aeruginosa(9.5%),Acinetobacter baumannii(8.7%),and Enterobacter cloacae(6.6%).The prevalence of methicillin-resistant Staphylococcus aureus(MRSA)was 19.7%in Staphylococcus aureus,and the prevalence of methicillin-resistant coagulase negative Staphylococcus(MRCNS)was 61.1%among coagulasenegative Staphylococcus(CNS).No vancomycin-resistant Enterococcus(VRE)or Staphylococcus was found.ESBLs-producing strains accounted for 47.6%in Escherichia coli and 16.9%in Klebsiella pneumonia isolates.A total of 14(0.9%)carbapenemresistant strains were identified among Enterobacteriaceae isolates.The prevalence of imipenem-resistant Acinetobacter baumannii was 42.8%.The prevalence of imipenem-resistant Pseudomonas aeruginosa was 7.4%.Conclusions The issue of antimicrobial resistance is of critical concern,esspecially MRSA,CRE,and carbapenem-resistant P.aeruginosa and A.baumannii.Ongoing surveillance of bacterial resistance is helpful for understanding the status of bacterial resistance,and can inform rational use of antimicrobial agents.