2014~2017年临床分离常见革兰阴性杆菌的临床分布特点及耐药性分析

Analysis of the characteristics of clinical distribution and drug resistance of common clinically isolated Gram-negative bacilli from 2014 to 2017

目的分析我院近4年临床分离常见革兰阴性杆菌的临床分布及耐药性特点,为感染相关疾病的早期治疗以及预防院内感染提供指导依据。方法收集我院2014~2017年各临床标本的分离株,法国生物梅里埃公司微生物菌株鉴定试条鉴定菌株,采用纸片扩散法进行药敏试验,采用WHONET5.6软件统计数据分析。结果我院从临床标本中的得到革兰阴性杆菌共20 270株,其中大肠埃希菌检出率最高,其次为肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌等。各分离菌主要集中在ICU,标本主要来源于呼吸道标本。大肠埃希菌对β-内酰胺类药物耐药率较高,而含酶抑制剂类的耐药率较低;肺炎克雷伯菌大多抗菌药物的耐药率略低于大肠埃希菌;鲍曼不动杆菌除了对替加环素的耐药率较低,对于其他抗菌药物耐药率高于60.00%;铜绿假单胞菌对部分抗菌药物的耐药率逐年降低;大肠埃希菌产ESBLs菌株检出率每年均稳定,肺炎克雷伯菌产ESBLs菌株检出率有所上升;CRE检出率较低,却有上升趋势;CRAb检出率每年均在70.00%左右,CRPa检出率有所下降。结论通过对细菌耐药性进行长期监测,可以有效地控制和预防耐药菌的出现和传播,预防院内感染,指导临床合理用药。

Objective To analyze the clinical distribution characteristics and the drug resistance of common Gram-negative bacilli in clinical isolates in our hospital in the past 4 years, providing guidance for early treatment of infection-related diseases and prevention of nosocomial infections. Methods The isolates of clinical specimens were collected from 2014 to 2017 in our hospital. The strains were identified by the bio-Mérieux strain of the French bio-Mérieux Company. The drug sensitivity test was carried out by the disk diffusion method, and the statistical data analysis was carried out by using WHONET5.6 software. Results A total of 20 270 Gram-negative bacilli were obtained from clinical specimens, and the detection rate of Escherichia coli was the highest, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacae. The isolates were mainly concentrated in the ICU, and the specimens were mainly derived from respiratory specimens. Drug resistance rate of Escherichia coli to β-lactam drugs was higher, while enzyme inhibitor was lower. The most antibacterial drugs resistance rate of Klebsiella pneumoniae was slightly lower than that of Escherichia coli. The other antibiotics resistance rate of Acinetobacter baumannii was higher than 60.00%, except to tigecycline. The drug resistance rate of Pseudomonas aeruginosa had decreased year by year. The detection rate of ESBLs produced by Escherichia coli was stable year by year, and the detection rate of ESBLs produced by Klebsiella pneumoniae was increased. The CRE detection rate retianed a lower rate, but it was an upward trend.The detection rate of CRAb was about 70.00% per year, and the detection rate of CRPa was decreased. Conclusion Through long-term monitoring of drug resistance of bacteria, the emergence and spread of drug-resistant bacteria could be effectively controlled and prevented, nosocomial infections could be prevented, and clinical rational drug using could be guided.