2017-2018年某二级医院临床分离菌株耐药性监测结果分析

The drug resistance surveillance of bacterial in a secondary grade hospital from 2017 to 2018

目的分析重庆市某二级医院临床分离菌株对常用抗菌药物的耐药性。方法采用全自动鉴定仪鉴定菌种,采用最小抑菌浓度法进行药敏实验检测。结果判读参照美国临床和实验室标准化协会2018年相关标准。结果2017-2018年共检出临床分离细菌5108株,其中革兰阴性菌3612株(70.7%),革兰阳性菌1496株(29.3%)。耐甲氧西林金黄色葡萄球菌检出率为26.9%,耐甲氧西林凝固酶阴性葡萄球菌检出率高达87.0%,未检出万古霉素、利奈唑胺、替加环素耐药葡萄球菌。肠球菌属细菌中屎肠球菌对多数抗菌药物的耐药率高于粪肠球菌,未检出万古霉素、替加环素、利奈唑胺耐药菌株。大肠埃希菌和肺炎克雷伯菌产超广谱β内酰胺酶的比例分别为50.8%和22.8%。肠杆菌科细菌对碳青霉烯类抗菌药物总体耐药率低于2.0%。铜绿假单胞菌对亚胺培南、美罗培南耐药率分别为12.1%和11.8%,鲍曼不动杆菌对亚胺培南和美罗培南的耐药率达到了45.0%和42.0%。结论该二级医院细菌耐药情况较为严重,需重视抗菌药物合理使用和感染控制工作。

Objective To investigate the drug resistance of clinical isolates in a secondary grade hospital. Methods Drug susceptibility tests were carried out by using minimum inhibitory concentration method,and results were analyzed according to 2018 standard of Clinic and Laboratory Standards Institute. Results A total of 5 108 clinical isolates were collected between from 2017 to 2018,of which gram negative organisms and gram positive organisms accounted for 70.7% and 29.3%,respectively.Methicillin resistant strains in S.aureus accounted for 26.9%,and methicillin resistant coagulase negative Staphylococcus strains accounted for 87.0%,respectively.No Staphylococcal strain was resistant to vancomycin,tigecycline or linezolid.The resistance rates of E.faecium strains to commonly used antibacterial agents were higher than E.faecalis .No E.faecium and E.faecalis strain was found to be resistant to vancomycin,tigecycline or linezolid.The overall resistance rates of strains of Enterobacteriaceae were less than 2.0%.The resistance rates of P.aeruginosa to imipenem and meropenem were 12.1% and 11.8%,respectively.The resistance rates of A.baumanii to imipenem and meropenem were 45.0% and 42.0%,respectively. Conclusion Drug resistance of bacterial strains could be serious in the secondary grade hospital,and more attention should be paid for the rational usage of antibiotics and infection control.