2019年北京协和医院细菌耐药性分析

Analysis of Antimicrobial Resistance in Peking Union Medical College Hospital in 2019

目的了解2019年北京协和医院分离的常见细菌对抗菌药物的耐药性。方法回顾性分析2019年1月1日至12月31日从北京协和医院分离的11404株非重复细菌的药敏结果。结果11404株细菌中革兰氏阴性菌占63.8%(7276/11404)、革兰氏阳性菌占36.2%(4128/11404)。葡萄球菌属中,甲氧西林耐药的金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)和甲氧西林耐药的凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococcus,MRCNS)的检出率分别为18.9%(191/1009)和77.3%(659/853),两者对红霉素的耐药率均较高(79.6%、83.2%)。肠球菌属中,屎肠球菌和粪肠球菌的检出率别为38.2%(437/1143)和54.6%(624/1143),对利奈唑胺(0.2%、0.3%)、万古霉素(4.3%、0.2%)和替考拉宁(3.0%、0)的耐药率较低。链球菌属中,肺炎链球菌、α溶血链球菌、A群和B群β溶血链球菌的检出率分别为12.8%(130/1012)、37.9%(384/1012)、4.2%(43/1012)和39.0%(395/1012),各菌种对红霉素、阿奇霉素和克林霉素的耐药率较高,其中肺炎链球菌和A群β溶血链球菌对此3种抗菌药物的耐药率均≥88.7%。肠杆菌科中,碳青霉烯类耐药肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)、肺炎克雷伯菌广泛耐药(extensive drug resistance,XDR)菌株的检出率分别为7.1%(308/4324)、4.7%(60/1273);肠杆菌科细菌对替加环素、碳青霉烯类和阿米卡星的耐药率较低。不发酵糖革兰氏阴性杆菌中,鲍曼不动杆菌对替加环素的耐药率最低(6.9%),对哌拉西林的耐药率最高(93.3%);铜绿假单胞菌对阿米卡星的耐药率最低(4.5%),对左氧氟沙星的的耐药率最高(22.6%);鲍曼不动杆菌和铜绿假单胞菌中XDR菌株的检出率为12.3%(117/949)和1.8%(21/1137)。流感嗜血杆菌中,β-内酰胺酶的阳性率为34.1%(45/132);流感嗜血杆菌对氨苄西林的耐药率最高(62.9%),除氯霉素外对其他抗菌药物的耐药率为33.3%~48.4%。结论2019年北京协和医院分离的常见细菌对常用抗菌药物有不同程度的耐药,可能对抗菌药物的合理使用和科学管理有指导作用。

Objective To investigate the antimicrobial resistance of clinical bacterial isolates in Peking Union Medical College Hospital(PUMCH)in 2019.Methods The antimicrobial resistance of 11404 non-duplicated common bacteria isolated from PUMCH during January 1 to December 31,2019 were retrospectively analyzed.Results In the totally 11404 clinical isolates,Gram-negative bacilli and gram-positive cocci accounted for 63.8%(7276/11404)and 36.2%(4128/11404),respectively.Methicillin-resistant Staphylococcus aureus(MRSA)and Methicillin-resistant coagulase-negative Staphylococcus(MRCNS)accounted for 18.9%(191/1009)and 77.3%(659/853),respectively,both of which had a high resistance rate to erythromycin(79.6%,83.2%).Enterococcus faecium and Enterococcus faecalis accounted for 38.2%(437/1143)and 54.6%(624/1143)in Enterococci,respectively;and the resistance rates to linezolid(0.2%,0.3%),vancomycin(4.3%,0.2%)and teicoplanin(3.0%,0)were low.The detection rates of Streptococcus pneumoniae,α-hemolytic Streptococcus,group A and group Bβ-hemolytic Streptococcus were 12.8%(130/1012),37.9%(384/1012),4.2%(43/1012)and 39.0%(395/1012)in Streptococcus,respectively.The resistance rates of all strains to erythromycin,azithromycin and clindamycin were more than 88.7%in Streptococcus pneumoniae and groupβ-hemolytic Streptococcus.Among the Enterobacteriaceae,the detection rates of carbapenem resistant Enterobacteriaceae(CRE)and extensive drug resistance(XDR)strains in Klebsiella pneumoniae were 7.1%(308/4324)and 4.7%(60/1273),respectively.The resistance rates of Enterobacteriaceae to tigecycline,carbapenems and amikacin were low.Among the non-fermentative Gram negative bacilli,Acinetobacter baumannii had the lowest resistance rate to tigecycline(6.9%)and the highest resistance rate to piperacillin(93.3%);Pseudomonas aeruginosa had the lowest resistance rate to amikacin(4.5%)and the highest resistance rate to levofloxacin(22.6%).The detection rates of XDR strains in Acinetobacter baumannii and Pseudomonas aeruginosa were 12.3%(117/949)and 1.8%(21/1137),repectively.Among Haemophilus influenzae,the positive rate ofβ-lactamase was 34.1%(45/132);the resistance rate to ampicillin was the highest(62.9%);the resistance rate to other antibiotics except chloramphenicol were 33.3%-48.4%.Conclusions The common bacteria isolated from PUMCH in 2019 have different degrees of resistance to commonly used antibiotics,which may play a guiding role in the rational use and scientific management of antibiotics.