2017年度西藏与上海两家三甲医院细菌与抗菌药物耐药分析

Analysis of the bacterial and antibacterial drug resistance spectrum of the top three hospitals in Tibet and Shanghai in 2017

目的通过对西藏地区某三甲医院与上海市某三甲医院2017年度细菌分布及耐药情况进行比较分析,了解西藏地区与上海地区的细菌类型及耐药抗菌谱的差异,为不同地区合理用药提供参考。方法对2017年西藏自治区人民医院和上海交通大学附属第六医院临床分离细菌,采用标准纸片扩散法或自动化仪器检测法,依据CLSI 2016年标准,用WHONET 5.6软件进行数据分析,比较两地相同菌属的耐药情况。结果西藏地区和上海地区共收集细菌分别为1454株和4864株。西藏医院革兰阴性菌分离率前三位的是大肠埃希菌(23.87%),肺炎克雷伯菌(13.55%)和鲍氏不动杆菌(10.52%),而上海医院则为大肠埃希菌(24.69%),肺炎克雷伯菌(12.87%)和铜绿假单胞菌(8.88%)。西藏地区未检出对亚胺培南耐药的肺炎克雷伯菌,而上海某三甲医院的检出率则为30.03%;鲍氏不动杆菌在两家医院之间的耐药率差异无统计学意义;铜绿假单胞菌在两家医院之间的耐药性存在一定差异,其中耐碳青霉烯铜绿假单胞菌(Carbapenem-resistant pseudomonas aeruginosa,CRPAE)的检出率西藏为17.86%,上海为29.86%(P=0.025);革兰阳性菌中,金黄色葡萄球菌分离率最高,西藏为13.27%,上海为14.86%;西藏地区耐甲氧西林金黄色葡萄球菌(Methicillin-resistant staphylococcus aureus,MRSA)的检出率为57.51%高于上海41.63%(P<0.001),两家医院均未发现万古霉素和替考拉宁不敏感的葡萄球菌;西藏地区未检出耐万古霉素肠球菌(Vancomycin resistant enterococcus,VRE),而上海地区检出率为0.60%,但西藏地区肠球菌对氨苄西林的耐药率高于上海地区(P<0.001)。结论西藏地区与上海地区两家医院细菌分布和构成相似。不同种类细菌之间耐药谱存在一定的差异,重要及特殊耐药菌检出率也有地区上的差别,因此需要建立本地区的细菌耐药监测网,了解本地区的细菌耐药特征,不同地区应根据本地细菌耐药监测结果进行感控管理,促进抗菌药物合理应用。

OBJECTIVE To understand the differences in bacterial types and drug resistance and antibacterial spectrum by comparing and analyzing the distribution of bacteria and drug resistance in the top three hospitals in Tibet and Shanghai in 2017,so as to provide references for the rational use of drugs in different regions.METHODS The bacteria isolated from the people’s Hospital of Tibet Autonomous Region and Shanghai Jiaotong University in 2017 were tested by standard paper diffusion method or automated instrument detection method.According to the 2016 standard of CLSI,data analysis was performed using WHONET 5.6 software to compare the drug resistance of the same genus in the two places.RESULTS A total of 1454 and 4864 strains of bacteria were isolated in Tibet and Shanghai.The top three Gram-negative bacterial isolated from Tibet hospital were Escherichia coli(23.87%),Klebsiella pneumoniae(13.55%)and Acinetobacter baumannii(10.52%),while the top three Gram-negative bacterial in Shanghai were E.coli(24.69%),K.pneumoniae(12.87%)and Pseudomonas aeruginosa(8.88%).K.pneumoniae resistant to imipenem was not detected in Tibet hospital,and the detection rate of that in a top three hospital of Shanghai was 30.00%.There was no significant difference in the resistance rate of A.baumannii between the two hospitals,and there was a certain difference in the resistance of P.aeruginosa between the two hospital.Among them,the detection rate of carbapenem-resistant P.aeruginosa(CRPAE)was 17.86%in Tibet and 29.86%in Shanghai(P=0.025).Among Gram-positive bacterial,Staphylococcus aureus was the first rank isolated from two hospitals(Tibet 13.23%,Shanghai 14.86%).The detection rate of methicillin-resistant S.aureus(MRSA)in Tibet was 57.51%,significantly higher than that in Shanghai(41.63%,P<0.001).Neither of the two hospitals found insensitive Staphylococci to vancomycin,linezolid and teicoplanin.No vancomycin resistant Entercoccus(VRE)was detected in Tibet,while the detection rate of that in Shanghai was 0.60%(P<0.001),but the resistance rate of Entercoccus to ampicillin in Tibet was significantly higher than that in Shanghai.CONCLUSION The distribution and composition of bacteria in representative hospitals in Tibet and Shanghai were similar.There is a certain difference in the drug resistant spectrum between different types of bacteria,and there are regional differences in the detection rate of important and special drug-resistant bacteria.Therefore,it is necessary to establish a bacterial resistance monitoring network in this area to understand the characteristics of bacterial resistance in this area.Different regions should conduct sensory management based on the results of local bacterial resistance monitoring to promote the rational application of antibacterial drugs.