2011-2018年滨州市某院大肠埃希菌的分布及耐药性

Distribution and drug resistance of Escherichia coli isolated in one hospital of Binzhou during 2011-2018

目的了解某地区住院患者血液样本分离大肠埃希菌的临床分布及其对抗菌药物的耐药性。方法回顾性分析滨州医学院附属医院2011—2018年住院患者血液分离大肠埃希菌且符合血流感染诊断的非重复样本。应用质谱仪、Walkaway96全自动微生物鉴定及药敏仪对菌株进行鉴定和药敏试验,K-B法作为补充,依据CLSI 2017年标准判定结果。结果共收集大肠埃希菌1074株,广泛分布于各个临床科室,以消化内科为主(216株,20.1%)。大肠埃希菌对碳青霉烯类抗菌药物的耐药率为0.27%(3/1074),对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、替卡西林/克拉维酸、阿莫西林/克拉维酸的耐药率较低(均<5.0%)。2011—2018年大肠埃希菌对庆大霉素、阿米卡星、妥布霉素等13种抗菌药物的耐药率差异具有统计学意义(χ^2>14.07,P<0.05)。ESBLs检出率自2014年开展以来呈逐年下降,差异有统计学意义(χ^2=34.291,P<0.05)。不同年龄组患者间分离的大肠埃希菌耐药率差异均无统计学意义(P均>0.05)。结论滨州地区住院患者血液样本分离大肠埃希菌分布广泛,对常用抗菌药物耐药情况不同,临床应根据药敏试验结果合理选择抗菌药物。

Objective To investigate the distribution of Escherichia coli(E.coli)isolated from blood specimens in one hospital and changes of antimicrobial resistance.Methods A retrospective analysis was made on the non-repeated blood specimens which isolated from inpatients with bloodstream infection from 2011 to 2018 in Affiliated Hospital of Binzhou Medical College.Strain identification and drug susceptibility analysis were adopted by mass spectrometer and Walkaway96,and supplemented by K-B test.The results were determined according to CLSI standard 2017.Results A total of 1074 strains of non-repeated E.coli were collected,and were widely distributed in clinical departments,especially in Department of Digestive Internal(216 strains,20.1%).Carbapenem-resistant E.coli(CRE)accounted for 0.27%(3/1074).E.coli showed low resistance(all<5.0%)to piperacillin/tazobactam,cefoperazone/sulbactam,clavulanate/clavulanic acid,amoxicillin/clavulanic acid.From 2011 to 2018,the resistance rates of E.coli to 13 antimicrobial agents including gentamicin,amikacin,tobramamycin were significantly different(χ^2>14.07,P<0.05).The detection rate of extended-spectrum beta-lactamases(ESBLs)had decreased statistically since 2014(χ^2=34.291,P<0.05).The resistance rates of strains in different age groups showed no significant difference(P>0.05).Conclusions E.coli which isolated from blood specimens is widely distributed in this district,and shows various levels of resistance to common antimicrobial agents.Antibiotics should be prescribed reasonably according to the local susceptibility testing data.