某三甲医院主要革兰阳性菌临床分布及耐药性分析

Clinical Distribution and Drug Resistance Analysis of Major Gram-positive Bacteria in a Third-Class Hospital

目的了解大连市友谊医院2018年常见革兰阳性菌的耐药情况及耐药迁徙率分析。方法收集友谊医院细菌室2018年324株革兰阳性细菌进行菌种鉴定的体外药物敏感性试验。结果324株革兰阳性细菌中,金黄色葡萄球菌134株(30%),屎肠球菌84株(19%),表皮葡萄球菌61株(14%),粪肠球菌45株(10%),这四种主要细菌占所检出的革兰阳性菌的73%。在细菌的科室分布中,医学重症科内科(16.05%)和泌尿科(16.36%)是检出革兰阳性细菌最多的科室,而标本来源可知尿液(32.1%)和痰液(19.14%)为检出率最高的标本。检出的最主要的四种细菌中,金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌和屎肠球菌对抗生素的耐药种类及相应的耐药率表现出不同的特点。检测的四种主要细菌中,有三种对青霉素有高度耐药性,分别是屎肠球菌(95.2%)、金黄色葡萄球菌(92.5%)和表皮葡萄球菌(90.2%),并且细菌对红霉素耐药性也较高,但耐药率不如青霉素,分别是金黄色葡萄球菌(64.9%)、表皮葡萄球菌(73.8%),粪肠球菌(71.1%)和屎肠球菌(85.7%)。粪肠球菌、金黄色葡萄球菌和表皮葡萄球菌对万古霉素和替考拉宁百分之百敏感。值得注意的是,屎肠球菌对万古霉素(94%)和替考拉宁(94%)敏感率较以前有所下降,疑似出现耐药菌株,需引起关注。金黄色葡萄球菌和表皮葡萄球菌对奎奴普汀/达福普汀百分之百敏感,屎肠球菌和粪肠球菌对替加环素百分之百敏感。结论四种细菌对青霉素类和大环内酯类抗生素的耐药性强,对多肽类抗生素敏感。应进行长期动态耐药性检测,为临床用药的合理化和个体化提供参考依据,避免药物滥用现象的出现。

Objective To investigate the drug resistance and migration rate of common Gram-positive bacteria in Dalian Friendship Hospital in 2018.Methods 324 strains of Gram-positive bacteria in the bacterial room of Friendship Hospital in 2018 were collected for in vitro drug sensitivity test.Results Of the 324 Gram-positive bacteria,134 were Staphylococcus aureus(30%),84 were Enterococcus faecium(19%),61 were Staphylococcus epidermidis(14%),45 were Enterococcus faecalis(10%).These four main bacteria accounted for 73%of the Grampositive bacteria detected.In the distribution of bacteria,the Department of Severe Medicine(16.05%)and Urology(16.36%)were the departments with the highest detection of Gram-positive bacteria,while urine(32.1%)and sputum(19.14%)had the highest detection rate.Among the four main bacteria detected,Staphylococcus aureus,Staphylococcus epidermidis,Enterococcus faecalis and Enterococcus faecium were resistant to antibiotics and the corresponding drug resistance rates were different.In the four main bacteria tested,three were highly resistant to penicillin,they were Enterococcus faecium(95.2%),Staphylococcus aureus(92.5%)and Staphylococcus epidermidis(90.2%).Erythromycin resistance was also higher,but the resistance rate was not as good as penicillin,which were Staphylococcus aureus(64.9%),Staphylococcus epidermidis(73.8%)Enterococcus faecalis(71.1%)and Enterococcus faecium(85.7%).Enterococcus faecalis,Staphylococcus aureus and Staphylococcus epidermidis are 100%sensitive to vancomycin and teicoplanin.It is worth noting that the sensitivity rate of Enterococcus faecium to vancomycin(94%)and teicoplanin(94%)are lower than before.Staphylococcus aureus and Staphylococcus epidermidis are 100%sensitive to dafuptin,Enterococcus faecium and feces Enterococcus is 100%sensitive to tegacycline.Conclusion The four bacteria are resistant to penicillin and macrolides and sensitive to polypeptide antibiotics.Long-term dynamic drug resistance detection should be carried out to provide reference for the rationalization and individualization of clinical drug use and avoid drug abuse.