2014-2018年十堰地区大肠埃希菌临床分布及耐药性变迁

Clinical distribution and drug resistance change of escherichia coli in Shiyan area from 2014 to 2018

目的探讨大肠埃希菌的临床感染分布及对常见抗菌药物的耐药性变迁,为临床经验性用药及合理使用抗菌药物提供实验室依据。方法回顾性分析十堰地区该院2014-2018年临床分离的大肠埃希菌的临床分布及耐药性变迁,采用珠海迪尔DL-96Ⅱ进行菌株的鉴定和最低抑菌浓度药敏试验。结果2014-2018年,从临床各类标本中共分离到大肠埃希菌2 483株,其中男性患者811株,女性患者1 672株,分离的大肠埃希菌主要来自于中段尿标本(62.1%)、痰液(14.8%)、血液(12.4%),科室分布主要集中在肾病内科(16.5%)、泌尿外科(11.0%)、老年病科(10.2%)及内分泌科(8.5%)。药敏试验结果显示,产超广谱β内酰胺酶(ESBL)大肠埃希菌组和非产ESBL大肠埃希菌组对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南、美罗培南、阿米卡星、米诺环素和呋喃妥因敏感性超过80.0%。耐药性变迁结果显示,大肠埃希菌产ESBL菌株的比例、对头孢哌酮/舒巴坦、氨苄西林/舒巴坦的耐药性有逐年下降的趋势,产ESBL组对抗菌药物敏感性低于非产ESBL组。耐碳青霉烯大肠埃希菌检出率较低,对亚胺培南和美罗培南耐药性稳定在1.0%以下。2014-2018年,三代头孢耐药及喹诺酮耐药大肠埃希菌检出率呈逐年下降趋势,检出率均稳定在50.0%左右。结论该院大肠埃希菌分离的标本主要来自于泌尿道、呼吸道、血液标本,主要集中在肾病内外科、老年科及内分泌科。对青霉素、二/三代头孢、喹诺酮类、磺胺类药物耐药情况较高(>50.0%),对头孢及酶抑制剂联合药类、碳青霉烯类、四环素类及硝基呋喃类(仅对尿道感染)药物较为敏感(>85.0%),可为临床经验性用药提供参考依据。

Objective To investigate the distribution of clinical infection of escherichia coli and the change of drug resistance to common antibiotics,so as to provide laboratory evidence for clinical empirical drug use and rational use of antibiotics.Methods The clinical distribution and drug resistance of escherichia coli isolated from Shiyan hospital from January 2014 to December 2018 were retrospectively analyzed.The strains were identified by DL-96Ⅱand the drug sensitivity test of the lowest inhibitory concentration was carried out.Results From 2014 to 2018,2 483 strains of escherichia coli were isolated from clinical specimens,811 strains were male and 1 672 strains were female.Escherichia coli mainly came from middle urine(62.1%),sputum(14.8%)and blood(12.4%).The distribution of these strains was mainly in nephrology(16.5%),urology(11.0%),geriatrics(10.2%)and endocrinology(8.5%).Drug susceptibility test showed that the sensitivity of extended-spectrum-lactamase(ESBL)-producing escherichia coli and non-ESBL-producing escherichia coli to cefoperazone/sulbactam,piperacillin/tazobactam,imipenem,meropenem,amikacin,minocycline and furantoin exceeded 80.0%.The results showed that the proportion of ESBL-producing strains and the resistance to cefoperazone/sulbactam and ampicillin/sulbactam decreased year by year.The sensitivity of ESBL-producing group to antibiotics was lower than that of non-ESBL-producing group.The detection rate of carbapenem-resistant escherichia coli was low,and the resistance to imipenem and meropenem was stable below 1.0%.From 2014 to 2018,the detection rates of third-generation cephalosporin-resistant and quinolone-resistant escherichia coli showed a decreasing trend year by year,and the detection rates were stable at about 50.0%.Conclusion Escherichia coli isolated from the hospital mainly come from urinary tract,respiratory tract,blood samples,mainly concentrated in nephrology,geriatrics and endocrinology.The drug resistance to penicillin,second or third generation cephalosporins,quinolones and sulfonamides was higher(>50.0%).The combination of cephalosporins and enzyme inhibitors,carbapenems,tetracyclines and nitrofurans(only for urethral infection)were more sensitive(>85.0%)and could provide reference for clinical empirical drug use.