2017-2019年包头地区某三级医院临床分离菌分布及耐药性分析

Analysis of clinical separation of bacteria in a tertiary hospital in Baotou region from 2017 to 2019

目的:了解包头地区某三级医院2017-2019年临床常见标本病原菌分布及对常用抗菌药物的敏感性和耐药性,为合理使用抗菌药物提供依据。方法:收集该院2017年1月至2019年12月临床分离细菌,采用全自动细菌鉴定药敏仪或纸片扩散法进行抗菌药物的敏感性试验,按照2019年美国临床和实验室标准化协会(CLSI)推荐的药敏试验方法进行结果判定。用自编Excel软件从LIS数据库中采集2017-2019年住院病人临床病原菌数据数据,统计分析采用SPSS 25.0软件。结果:三年间共检出临床分离菌2220株,其中革兰阳性细菌581株(26.2%),革兰阴性菌1639株(73.8%)。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为14.2%。MRSA对大多数抗菌药物耐药率明显高于甲氧西林敏感金黄色葡萄球菌(MSSA),且对青霉素的耐药率达100%。未发现对万古霉素耐药的金黄色葡萄球菌。屎肠球菌对多数抗菌药物的耐药性高于粪肠球菌,发现1株耐万古霉素的屎肠球菌,未发现对万古霉素的耐药的粪肠球菌。肺炎链球菌对克林霉素、红霉素和四环素的耐药率均较高(47.6%)。超广谱β-内酰胺酶(ESBLs)阳性的大肠埃希菌和肺炎克雷伯菌的检出率分别是46.4%、19.7%。产ESBLs菌株对所测抗菌药物的耐药率除碳青霉烯类外均大于非产ESBLs菌株。大肠埃希菌产ESBLs菌株对头孢噻肟、头孢唑林、氨苄西林、哌拉西林的耐药率均高达95%以上;肺炎克雷伯菌产ESBLs菌株对阿米卡星、莫西沙星敏感,且未检出对亚胺培南、美罗培南耐药菌株。耐碳青霉烯类肠杆菌科细菌(CRE)检出率为0.4%(9/2220),分别为大肠埃希菌2株,肺炎克雷伯菌1株(非产ESBLs),阴沟肠杆菌1株,变形杆菌属5株(奇异变形杆菌4株,普通变形杆菌1株)。耐青霉烯类鲍曼不动杆菌(CRAB)检出率8.9%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为15.2%和11.6%。结论:该院细菌耐药形势已日益严峻,尤其是多重耐药应引起高度重视,还应加强抗菌药物的合理使用和感控措施,同时做好细菌耐药监测工作。

Objective:To understand the distribution of pathogens and sensitivity and resistance to commonly used antimicrobial drugs in a three-level hospital in Baotou region in 2017-2019,and to provide a basis for the rational use of antimicrobial drugs.Methods:The hospital was clinically isolated bacteria in January 2017,and the sensitivity test of antimicrobial drugs was carried out using a fully automatic bacterial identification drug meter or paper-chip diffusion method,and the results were determined according to the drug sensitivity test recommended by the American Society for Clinical and Laboratory Standardization(CLSI)in 2019.Self-edited Excel software is used to collect data data on clinical pathogens in inpatients from 2017-2019,and statistical analysis uses SPSS 25.0 software.Results:A total of 2220 strains of clinical isolates were detected in the past three years,including 581(26.2%)Gram-positive bacteria and 1639(73.8%)Gram-negative bacteria.The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was 14.2%.MRSA is significantly higher to most antibacterial bacteria than MSSA,and the resistance rate to penicillin is 100.0%.No Staphylococcus aureus resistant to vancomycin was found.Enterococcus faecium is more resistant to most antibacterial drugs than Enterococcus faecalis.One strain of Enterococcus faecium was found to be resistant to vancomycin,and no Enterococcus faecalis resistant to vancomycin was found.The resistance rates of Streptococcus pneumoniae to clindamycin,erythromycin and tetracycline were high(=47.6%).The detection rates of extended-spectrumβ-lactamases(ESBLs)positive Escherichia coli and Klebsiella pneumoniae were 46.4%and 19.7%,respectively.The resistance rate of ESBLs-producing strains to the tested antibacterial drugs was higher than that of non-ESBLs-producing strains except for carbapenems.The resistance rate of ESBLs-producing strains of Escherichia coli to cefotaxime,cefazolin,ampicillin and piperacillin are all up to 95%;Klebsiella pneumoniae ESBLs-producing strains are sensitive to amikacin and moxifloxacin,and no resistant strains to imipenem and meropenem were detected.The detection rate of Carbapenem-resistant Enterobacteriaceae(CRE)was 0.4%(9/2220),2 strains of Escherichia coli,1 strain of Klebsiella pneumoniae(non-ESBLs),and Enterobacter cloacae 1 strain,5 strains of the genus Proteus(4 strains of Proteus mirabilis,1 strain of Proteus vulgaris).The detection rate of penicillene-resistant Acinetobacter baumannii(CRAB)was 8.9%.The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 15.2%and 11.6%,respectively.Conclusion:The situation of bacterial resistance in this hospital has become increasingly severe,especially multi-drug resistance should be paid more attention to.The rational use of antimicrobials and infection control measures should be strengthened,and the monitoring of bacterial resistance should be done well.