2013至2017年5种常见多药耐药菌的耐药性分析

Analysis for the drug resistance of 5 common multidrug resistance bacteria in clinic from 2013 to 2017

目的了解2013至2017年临床5种重要分离菌的耐药性变迁,为临床合理性用药提供依据。方法回顾性分析2013年1月至2017年12月临床科室送检标本耐药菌株的耐药情况。应用法国生物梅里埃全自动微生物鉴定仪进行鉴定,并做临床常用抗菌药物的耐药性分析。结果 5年共分离出耐药阳性菌株174 953株,排名前五位的分别是:大肠埃希氏菌(5 201株)、铜绿假单胞菌(4 240株)、金黄色葡萄球菌(2 818株)、肺炎克雷伯菌(2 229株)、鲍曼不动杆菌株(1 633株)。大肠埃希菌中产ESBLs菌株检出率为49.38%～60.72%、肺炎克雷伯菌产ESBLs菌株检出率为33.67%～41.99%。产ESBLs的菌株均对酶抑制剂复合制剂、头霉素类、碳青霉烯类抗生素以及阿米卡星具有很高的敏感性,产ESBLs菌株的耐药性普遍高于非产ESBLs菌株;耐甲氧西林金黄色葡萄球菌(MASSA)的检出率为49.65%～43.5%,其中耐甲氧西林金黄色葡萄球菌(MRSA)对复方新诺明、庆大霉素的耐药率低于甲氧西林敏感型金黄色葡萄球菌(MSSA),其他抗菌药物耐药率MRSA均高于MSSA。未检出耐万古霉素、替加环素及利奈唑胺的金黄色葡萄球菌。多重耐药的鲍曼不动杆菌对米诺环素、左氧氟沙星、复方新诺明耐药率较低,对其他药物耐药率均较高;铜绿假单胞菌除氨曲南的耐药率高于30%外,其他抗菌药物的耐药率均在30%以下,具有较高敏感性;除鲍曼不动杆菌外,其他几种细菌的多药耐药性均呈下降或稳定的趋势。结论动态监测细菌的耐药性对临床合理选择抗生素具有重要的指导作用。

Objective To investigate the changes of drug resistance of 5 common multidrug resistance bacteria in clinic from 2013 to 2017,so as to provide evidence for rational use of drugs in clinical practice.Methods The antibiotic resistance data of drug resistant strains isolated from the specimens in clinical departments in our hospital from January 2013 to December 2017 were restropectively analyzed,which were identified by using French biology-biomerieux ATB bacterial identification system,moreover, the drug resistance analysis of clinical common antibacterials was performed.Results A total 174 953 drug resistance positive strains were isolated from clinical specimens in five years. The top five strains were E.coli(5,201 strains),pseudomonas aeruginosa(4,240 strains) taphylococcus aureus(2,818 strains) lebsiella pneumoniae(2,229 strains) cinetobacter baumannii(1,633 strains).The detection rate of ESBL strains from E.coli was 49.38%~60.72%,klebsiella pneumoniae was 33.67%~41.99%.ESBL(Extended-Spectrum β-Lactamases) was highly sensitive to cephalosporins and amikacin,The drug resistance of ESBL producing strain was generally higher than that of non-ESBL producing strain.The detection rate of mrsa(MASSA) was 49.65%~ 43.5%. Among them,MRSA had a lower resistance rate to compound neosporin gentamicin than that of MSSA,and the other antimicrobial drugs had a higher resistance rate to MRSA than MSSA.The staphylococcus aureus resistant to vancomycin tegacycline and linazolamide were not detected.The drug resistance rate of multidrug-resistant acinetobacter baumannii to minocycline levofloxacin compound was lower,however,which to other drugs was higher.The drug resistance rate of pseudomonas aeruginosa was higher than 30%,and other antibiotics were less than 30%,which was highly sensitive except for acinetobacter baumannii.Moreover the multidrug resistance of the other several bacteria showed a decreasing or stable trend.Conclusion The dynamic monitoring of bacterial resistance plays an important role in the rational selection of antibiotics in clinical practice.