2015～2017年广州市某院细菌耐药监测结果分析

Analysis of Bacterial Resistance in a Hospital of Guangzhou from 2015 to 2017

目的分析某院住院患者细菌感染标本病原菌的种类及耐药性,为临床合理使用抗菌药物提供依据。方法用DL-96细菌测定系统进行鉴定和药敏试验,采用WHONET 5.6软件对2015~2017年住院患者分离的2 981株非重复菌株进行数据分析。结果 2 981株标本主要主要由痰液(56.36%)、尿液(31.49%)、分泌物(7.47%)组成。其中革兰阴性杆菌2 581株(86.58%),以铜绿假单胞菌719株(24.12%)居首位;革兰阳性球菌324株(10.87%),以金黄色葡萄球菌142(4.76%)居首位。革兰阴性杆菌整体耐药水平较高,以鲍曼不动杆菌耐药最为严重。大肠埃希菌和奇异变形杆菌对碳青霉烯类药物仍高度敏感,耐药率低于5%。耐碳青霉烯类铜绿假单胞菌和鲍曼不动杆菌的检出率分别为35.33%、58.63%,两者对多黏菌素B高度敏感。产超广谱β-内酰胺酶(ESBLs)大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌的检出率分别为50.22%、38.41%、23.40%,对碳青霉烯类药物耐药率均低于5%。革兰阳性球菌中金黄色葡萄球菌对利奈唑胺、替考拉宁高度敏感,未发现对万古霉素耐药的金黄色葡萄球菌株。结论该院下呼吸道感染、泌尿系感染标本较多,铜绿假单胞菌的分离率较高,总体耐药形势比较严峻,应加强细菌耐药监测,用监测结果指导临床合理使用抗菌药物,减缓细菌耐药性的产生。

OBJECTIVE To analyze the species and drug resistance of pathogenic bacteria in inpatients with bacterial infection in a hospital,so as to provide evidence for rational use of antibacterial drugs in clinic. METHODS The DL-96 bacterial assay system was used for identification and drug susceptibility test.The data of 2 981 non-repetitive pathogens isolated from 2015 to 2017 were analyzed by WHONET 5.6 software. RESULTS The 2 981 specimens were mainly composed of sputum( 56. 36%),urine( 31. 49%) and secretions( 7.47%).Among them,2 581( 86.58%) isolates were gram-negative bacilli,and Pseudomonas aeruginosa( 719,24.12%)ranked first.324( 10. 87%) isolates were gram-positive cocci,with Staphylococcus aureus( 142,4. 76%) ranked first. The overall resistance level of gram-negative bacilli was high,and the resistance of Acinetobacter baumannii was the most serious. Escherichia coli and Proteus mirabilis were still highly sensitive to carbapenem,and the drug resistance rate was less than 5%. The detection rates of carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii were 35. 33% and 58. 63%,respectively,both of them were highly sensitive to polymyxin B. The detection rates of ESBLs produced by Escherichia coli,Klebsiella pneumoniae,and Proteus mirabilis were 50. 22%,38. 41%,23. 40%,their resistance rates to carbapenems were less than 5%. Grampositive cocci Staphylococcus aureus was sensitive to linezolid and teicoplanin,and no strain of Staphylococcus aureus resistant to vancomycin was found. CONCLUSION There are many specimens of lower respiratory tract infection and urinary infection in hospital.The isolation rate of Pseudomonas aeruginosa is high,and the overall drug resistance situation is severe. We should strengthen the monitoring of bacterial resistance,use the results of bacterial resistance to guide the rational use of clinical antibiotics and slow down the production of bacterial resistance.