某院近5年住院患者肠杆菌科细菌分布及耐药监测分析

Analysis on bacterial distribution and drug resistance monitoring of Enterobacteriaceae among inpatients in a hospital during recent five years

目的对该院2013-2017年住院患者分离的肠杆菌科细菌分布及药敏情况进行统计分析,为临床治疗及合理选择抗菌药物提供依据。方法采用纸片扩散法(K-B法)或自动化仪器(VITEK2-compact系统)对临床分离的5562株非重复肠杆菌科细菌进行药敏试验,并按美国临床实验室标准化协会(CLSI)相关标准判断药敏结果。结果共收集该院临床分离的非重复肠杆菌科细菌5562株,其中大肠埃希菌2820株,肺炎克雷伯菌1607株,阴沟肠杆菌317株及其他肠杆菌科细菌818株。5年间肠杆菌科细菌的检出率基本持平,2013年为50.9%,2017年为51.1%。药敏试验数据显示,所有肠杆菌科细菌对哌拉西林/他唑巴坦、亚胺培南、厄他培南、头孢替坦和阿米卡星保持了高的敏感率(>90.0%),对头孢哌酮/舒巴坦、头孢他啶和头孢吡肟也有较高的敏感率(73.0%~89.3%),对氨曲南、庆大霉素、妥布霉素、左氧氟沙星、环丙沙星、氨苄西林/舒巴坦、头孢唑林、头孢曲松、复方磺胺甲噁唑的敏感率较低(27.3%~66.1%),对氨苄西林的敏感率最低(8.0%)。5年间,产超广谱β-内酰胺酶(ESBLs)大肠埃希菌检出率从62.7%上升到64.6%;产ESBLs肺炎克雷伯菌检出率从37.5%下降至30.5%。碳青霉烯类耐药肠杆菌科细菌(CRE)检出率为1.6%。结论肠杆菌科细菌对常见抗菌药物的耐药率总体呈下降趋势,但CRE菌株的日趋增多,给临床治疗造成严重影响,应充分利用细菌耐药监测结果进行感染控制,提高临床抗菌药物合理使用的意识,有效遏制该类菌株感染的发生。

Objective To statistically analyze the bacterial distribution and drug sensitivity situation of Enterobacteriaceae strains isolated from the inpatients in a hospital during 2013-2017 to provide an evidence for clinical treatment and rational selection of antibacterial agents.Methods The Kirby-Bauer method or automatic analyzer(VITEK2-compact)were adopted to conduct the drug susceptibility test on 5562 clinically isolated non-repeated strains of Enterobacteriaceae.The results were judged according to the CLSI 2017 related criteria.Results A total of 5562 clinically isolated non-repeated strains of Enterobacteriaceae were collected,in which 2820 strains were E.coli,1607 strains were Klebsiella spp.,317 strains were E.cloacae and 818 strains were other strains of Enterobacteriaceae.The detection rate of Enterobacteriaceae was basically equal during these 5 years,the rate was 50.9% in 2013,and the rate was 51.1% in 2017.The drug sensitivity test data showed that all Enterobacteriaceae maintained the high sensitivity(>90.0%)to piperacillin/tazobactam,imipenem,ertapenem,cefotetan and amikacin,high sensitivity(73.0%-89.3%)to cefoperazone-sulbactam,ceftazidime and cefepime,low sensitivity(27.3%-66.1%)to aztreonam,gentamicin,tobramycin,ciprofloxacin,levofloxacin,cefoperazone-sulbactam,cefazolin,ceftriaxone and trimethoprim-sulfamethoxazole,and the lowest sensitivity(8.0%)to ampicillin.During the 5-year period,the detection rate of ESBLs-producing E.coli strains was increased from 62.7% in 2013 to 64.4%in 2017,but the detection rate of ESBLs-producing Klebsiella spp.strains was decreased from 37.5% to 30.5%.The detection rate of carbapenem-resistant Enterobacteriaceae(CRE)was 1.6%.Conclusion The resistance rate of Enterobacteriaceae to commonly used antibacterial shows the overall decreasing trend,but the CRE strains are increased day by day,and cause the serious influence to clinic.The bacterial drug-resistant monitoring results should be fully applied to conduct the infection control,increase the rational use awareness of antibacterial drugs for effectively restraining the occurrence of these bacterial infection.