2014～2016年崇左市细菌耐药监测分析

Surveillance and analysis of bacterial resistance in Chongzuo City from 2014 to 2016

目的了解崇左市病原菌分布及耐药情况,掌握该区域细菌耐药变迁形势,为抗菌药的合理应用提供依据。方法统计分析崇左市辖区的七家综合性医院2014～2016年临床分离菌构成及细菌耐药情况。共收集病原微生物标本172 367份,分离出细菌18 256株。采用纸片法或最小抑菌浓度(MIC)法测定抗菌药的敏感性,试验标准与判定标准按各年的美国临床和实验室标准协会(CLSI)标准,用WHONET5.6软件对数据进行统计分析。结果崇左地区3年临床分离病原菌中革兰阳性菌占24.3%,革兰阴性菌占75.7%。2014～2016年分离病原菌中排在首位的革兰阳性菌均为金黄色葡萄球菌,第二位的均为表皮葡萄球菌;分离病原菌中革兰阴性菌排在前五位的依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、阳沟杆菌。2014～2016年崇左市甲氧西林耐药的金黄色葡萄球菌(MRSA)检出率依次为:18.3%、24.9%、26.0%,万古霉素耐药粪肠球菌检出率依次为:2.8%、0.0%、0.0%,未检出万古霉素耐药的屎肠球菌。2014～2016年,青霉素耐药肺炎链球菌(PRSP)和红霉素耐药肺炎链球菌(ERSP)检出率分别为:67.6%、68.9%、68.2%和92.3%、96.5%、94.4%。对第三代头孢菌素、碳青霉烯类和喹诺酮类耐药的大肠埃希菌检出率分别为:51.1%、47.8%、45.2%;0.9%、0.7%、0.4%和42.2%、44.6%、40.9%。对第三代头孢菌素和碳青霉烯类耐药的肺炎克雷伯菌检出率分别为:31.0%、26.6%、23.6%和0.7%、2.0%、1.8%。对碳青霉烯类耐药的铜绿假单胞菌和鲍曼不动杆菌检出率分别为:6.5%、14.4%、11.9%和25.4%、42.3%、38.6%。结论崇左市细菌耐药性严重,2014～2016年MRSA检出率呈逐年上升趋势,PRSP检出率远高于广西和全国平均水平,碳青霉烯类抗菌药的耐药率升高较快,应加强抗菌药应用管理和细菌耐药监测。

Objective To understand the distribution and drug resistance of pathogenic bacteria in Chongzuo City, and to grasp the situation of bacterial resistance change in this region, and provide a basis for the rational application of antibacterial drugs. Methods Data of clinical isolation pathogenic bacteria composition and drug resistance in 7 general hospitals from 2014 to 2016 were analysed. A total of 172 367 samples of pathogenic microorganisms were collected, in which 18 256 strains of bacteria were isolated. The paper method or minimal inhibitory concentration(MIC). method were used to determine the sensitivity of antibiotics. The test and judgment standards were applied according to the Clinical & Laboratory Standards Institute(CLSI) standards of each year. WHONET5.6 software was used for statistical analysis of data. Results From 2014 to 2016, Gram-positive bacteria accounted for 24.3% and Gram-negative bacteria75.7% of clinical isolates pathogenic bacteria in Chongzuo area. The Gram-positine Racteria ranked first in the isolated pathogens from 2014 to 2016 were Staphylococcus aures, and the second were Staphlococcus epidermidis;the Gramnegatiue becteria in the isolated pathogens ranked in the top five were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacea. From 2014 to 2016, the detection rates of methi-cillin-resistant Staphylococcus aureus(MRSA) were18.3%, 24.9%, 26.0% respectively, vancomycin-resistant Enterococcus faecalis were 2.8%, 0.0%, 0.0% respectively, and vancomycin-resistant Enterococcus faecium was not detected. From 2014 to 2016, the detection rates of penicillin-resistant Streptococcus pneumoniae(PRSP) and erythromycin-resistant Streptococcus pneumoniae(ERSP) were 67.6%, 68.9%, 68.2% and 92.3%,96.5% 94.4%, respectively. The third generation of cephalosporins-, carbapenems-and quinolones-resistant Escherichia coli were 51.1%, 47.8%4, 5.2%;0.9%, 0.7%, 0.4%;and 42.2%, 44.6%, 40.9%, respectively. The resistant rates of Klebsiella pneumoniae to the third generation of cephalosporins were 31.0%, 26.6%, 23.6%, and Klebsiella pneumoniae to carbapenems were 0.7%, 2.0%, 1.8%. The detection rates of carbapenems-resistant Pseudomonas aeruginosa and carbapenems-resistant Acinetobacter baumannii were 6.5%, 14.4%, 11.9% and 25.4%, 42.3%, 38.6% respectively. Conclusion It is serious of bacteria resistant to antibiotics in Chongzuo City. From 2014 to 2016, the detection rate of MRSA shows an increase trend, PRSP was higher than the average levels of Guangxi and China, and the drug resistance rate of carbapenems increased rapidly. Management of antimicrobial application and monitoring of bacterial resistance should be strengthened.