2018年陕西省人民医院细菌耐药性监测

Antibiotic resistance surveillance in the bacterial strains isolated from Shannxi Provincial People’s Hospital:2018 report

目的研究陕西省人民医院2018年临床分离菌的分布及耐药情况。方法采用纸片扩散法和自动化仪器法进行药敏试验,结果分析采用WHONET 5.6软件。结果2018年该院临床共分离出非重复菌株8001株,其中革兰阳性菌占24.0%(1919/8001),革兰阴性菌占76.0%(6082/8001)。葡萄球菌属中,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)的检出率分别为52.6%和69.4%。MRCNS中有2株(0.7%)对利奈唑胺耐药,其余葡萄球菌对万古霉素和利奈唑胺均全敏感。肠球菌属中粪肠球菌和屎肠球菌各占38.8%和56.1%。未发现对万古霉素、替考拉宁耐药的粪肠球菌,而屎肠球菌对两药的耐药率分别为0.6%和0.5%;粪肠球菌对利奈唑胺的耐药率为2.2%,屎肠球菌无耐药株。对头孢曲松耐药的大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌的检出率分别为57.1%、61.4%和65.4%。对亚胺培南和美罗培南,大肠埃希菌的耐药率均为1.2%,肺炎克雷伯菌的耐药率为57.7%和58.1%,铜绿假单胞菌的耐药率为41.6%和34.3%。鲍曼不动杆菌对多黏菌素B和替加环素耐药率分别为0.4%和2.7%,对阿米卡星、米诺环素、甲氧苄啶-磺胺甲[口恶]唑耐药率相对较低(18.9%~48.4%),对其他抗菌药物耐药率均较高(81.7%~95.7%)。结论该院临床分离菌耐药性处于较高水平,尤其是耐碳青霉烯类肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌,对临床的抗菌治疗构成严重威胁,应继续加强耐药性监测并加强抗菌药物的规范管理和使用。

Objective To study the distribution and antibiotic resistance profile of clinical bacterial isolates in Shaanxi Provincial People’s Hospital from January to December 2018.Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results A total of 8001 nonduplicate clinical isolates were collected,including gram-positive bacteria(24.0%,1919/8001)and gram-negative bacteria(76.0%,6082/8001).The prevalence of methicillin-resistant strains was 52.6%in Staphylococcus aureus(MRSA)and 69.4% in coagulase-negative Staphylococcus(MRCNS).All staphylococcal isolates were susceptible to vancomycin and linezolid,except 0.7% of MRCNS strains were resistant to linezolid.Of the enterococcal isolates,E.faecalis and E.faecium accounted for 38.8%and 56.1%,respectively.All E.faecalis isolates were susceptible to vancomycin and teicoplanin,2.2%of E.faecalis strains were resistant to linezolid.All E.faecium isolates were susceptible to linezolid,but some strains were resistant to vancomycin(0.6%)or teicoplanin(0.5%).The prevalence of the strains resistant to ceftriaxone was 57.1%in E.coli,61.4%in K.pneumoniae and 65.4% in Enterobacter cloacae.E.coli strains showed low resistance to imipenem(1.2%)and meropenem(1.2%).More than half of K.pneumoniae isolates were resistant to imipenem(57.7%)and meropenem(58.1%).About 41.6%of the P.aeruginosa isolates were resistant to imipenem and 34.3% were resistant to meropenem.A.baumannii isolates showed low resistance to polymyxin B(0.4%)and tigecycline(2.7%),and relatively low resistance(18.9%-48.4%)to amikacin,minocycline,and trimethoprim-sulfamethoxazole;but high resistance rates(81.7%-95.7%)to other antimicrobial agents.Conclusions Antibiotic resistance still poses a serious threat to clinical antimicrobial therapy,especially carbapenem-resistant K.pneumoniae,carbapenem-resistant P.aeruginosa,and carbapenem-resistant A.baumannii.More attention should be paid to antibiotic resistance surveillance,stewardship and rational use of antibiotics.