2016—2018年苏州市吴江区第一人民医院病原菌的分布及耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria in Suzhou Wujiang First People’s Hospital from 2016 to 2018

目的了解2016-2018年苏州市吴江区第一人民医院常见临床分离菌株的构成及细菌耐药性情况,为临床抗感染治疗用药提供参考,促进合理用药。方法采用自动化仪器法或纸片扩散法进行抗菌药物的敏感性试验,按照2017年临床和实验室标准化协会(CLSI)标准判读药敏结果,回顾性分析2016-2018年苏州市吴江区第一人民医院的病原菌分布及耐药性。结果共分离病原菌35 331株,革兰阴性菌22 860株,占64.70%,主要为大肠埃希菌(6 790株,29.70%)、铜绿假单胞菌(5 244株,22.94%)、肺炎克雷伯菌(4 250株,18.59%)、鲍曼不动杆菌(1 926株,8.43%)和嗜麦芽窄食单胞菌(1 753株,7.67%);革兰阳性菌9 676株,占27.39%,主要为金黄色葡萄球菌(5 138株,53.10%)、链球菌属(1 590株,16.43%)、肠球菌属(1 436株,14.84%)和凝固酶阴性葡球菌(928株,9.59%);真菌2 795株,占7.91%。革兰阴性菌中产ESBLs的大肠埃希菌、产ESBLs的肺炎克雷伯菌检出率分别为48.56%、24.66%;大肠埃希菌产ESBLs菌株对氨苄西林、头孢唑啉的耐药率达100.0%,对其他抗菌药物的耐药率呈逐年上升趋势;肺炎克雷伯菌产ESBL株对阿米卡星、妥布霉素、哌拉西林/他唑巴坦、亚胺培南较敏感;肠杆菌属细菌对绝大多数抗菌药物的耐药率均较低<30%(除头孢菌素类外);铜绿假单胞菌对大多数抗菌药物的耐药率无太大差别,3年来并无太大起伏变化,且均较低(<15%);鲍曼不动杆菌对氨苄西林/舒巴坦、头孢他啶的耐药率呈逐年上升趋势。革兰阳性菌中检出耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分别为35%、73.92%。MRSA和MRCNS对青霉素类、氟喹诺酮类、大环内酯类、四环素,复方新诺明等抗菌药物的耐药率均显著高于MSSA和MSCNS株,同时对青霉素G的耐药率均已达100.0%;3年间未检测出对万古霉素、利奈唑胺和呋喃妥因耐药的葡萄球菌属细菌;屎肠球菌对青霉素类、氟喹诺酮类、红霉素、万古霉素的耐药率均显著高于粪肠球菌;3年间未检测出对利奈唑胺耐药的肠球菌属细菌,但检出有少数对万古霉素耐药的肠球菌。结论 2016-2018年苏州市吴江区第一人民医院大肠埃希菌和鲍曼不动杆菌的耐药率呈逐年上升趋势,其他细菌的耐药情况较平稳,但仍应加强院感的防控及细菌监测管理。定期监测细菌耐药性有助于了解细菌耐药性的情况,及时掌握临床病原菌耐药变化的趋势,为医院感染防控提供依据,促进临床合理应用抗菌药物和科学管理。

Objective To understand the composition and bacterial resistance of common pathogenic bacteria in Suzhou Wujiang First People’s Hospital from 2016 to 2018, and to provide a reference for clinical anti-infective treatment to promote rational drug use. Methods The sensitivity test of antibacterial drugs was carried out by automated instrument method or paper diffusion method. The drug susceptibility results were interpreted according to the 2017 Clinical and Laboratory Standardization Association(CLSI) standard.The pathogen distribution and drug resistance in Suzhou Wujiang First People’s Hospital from 2016 to 2018 was retrospectively analyzed. Results A total of 35 331 clinical specimen were isolated, in which 22 860 strains were Gram-negative bacteria, accounting for 64.70%, mainly Escherichia coli(6 790 strains, 29.70%), Pseudomonas aeruginosa(5 244 strains, 22.94%), and Klebsiella pneumoniae(4 250 strains, 18.59%), Acinetobacter baumannii(1 926 strains, 8.43%), and Stenotrophomonas maltophilia(1 753 strains, 7.67%). Gram-positive bacteria were 9 676 strains(27.39%), and main of them were Staphylococcus aureus(5 138 strains, 53.10%), Streptococcus(1 590 strains, 16.43%), Enterococcus(1 436 strains, 14.84%), and coagulase-negative staphylococci(928 strains, 9.59%). Fungi were 2 795 strains, accounting for 7.91%. The detection rates of ESBLs produced by E. coli and K. pneumoniae in Gram-negative bacteria were 48.56% and 24.66%, respectively. The resistance rates of ESBLs strain produced by E. coli to ampicillin and cefazolin was 100.0%. The resistance rates to other antibacterial drugs was increasing over time. The ESBLs strain of K. pneumoniae was sensitive to amikacin, tobramycin, piperacillin/tazobactam, and imipenem. The resistance rates of Enterobacter bacteria to most antibacterial drugs were lower < 30%(except cephalosporins). P. aeruginosa had no resistance to most antibacterial drugs, and the difference was that there had not been much fluctuation in the past three years, and both were low(<15%). The resistance of A. baumannii to ampicillin/sulbactam and ceftazidene was increasing year by year. Methicillin-resistant S. aureus(MRSA) and methicillin-resistant coagulase-negative staphylococci(MRCNS) were detected in Gram-positive bacteria at 35% and 73.92%, respectively. The resistance rates of MRSA and MRCNS to antibiotics such as penicillins, fluoroquinolones, macrolides, tetracycline, and compound sulfamethoxazole were significantly higher than those of MSSA and MSCNS strains, and the resistance rates to penicillin G was reached to 100.0%. There was no Staphylococcus bacteria resistant to vancomycin, linezolid and nitrofurantoin detected in 3 years. The resistance rates of E. faecium to penicillins, fluoroquinolones, erythromycin, and vancomycin were significantly higher. There was no Enterococcus bacteria resistant to linezolid detected in 3 years, but a small number of vancomycin-resistant enterococci were detected. Conclusion From 2016 to 2018, the resistance rates of E. coli and A. baumannii have the tendency of increasing in Suzhou Wujiang First People’s Hospital from 2016 to 2018, while the resistance of other bacteria was stable. But the prevention and control within the hospital along with the monitoring and management of bacteria should be strengthened. Regularly monitoring the bacterial resistance can help to understand the bacterial resistance in the hospital, timely update the trend of drug resistance changes in clinical pathogens, and provide a basis for prevention and control of nosocomial infection and promote a rational use of antibacterial drugs and the scientific management.