2015—2019年齐齐哈尔市第一医院细菌耐药性监测

Surveillance of Bacterial Resistance from the First Hospital of Qiqihaer from 2015 to 2019

目的了解2015—2019年齐齐哈尔市第一医院临床常见分离菌的分布及耐药情况,为抗菌药物的合理使用提供参考。方法采用纸片扩散法和全自动仪器法进行抗菌药物的敏感性试验,依据美国临床和实验室标准化委员会(CLSI)2018年标准判读结果,使用WHONET 5.6进行分析。结果收集2015年1月—2019年12月非重复临床分离菌共19497株,其中革兰阳性菌5210株,占26.7%;革兰阴性杆菌14287株,占73.3%。排名前5位的细菌为克雷伯菌属19.4%、大肠埃希菌17.7%、金黄色葡萄球菌14.1%、铜绿假单胞菌12.3%和不动杆菌属8.0%。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为24.3%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率为76.9%,葡萄球菌属中未发现利奈唑胺和万古霉素耐药株。肠球菌属中屎肠球菌对多数抗菌药物耐药率显著高于粪肠球菌,屎肠球菌和粪肠球菌共检出9株对万古霉素耐药株。检出肺炎链球菌非脑膜炎分离株514株,成人和儿童所占比例分别为45.1%和54.9%,非脑膜炎分离株中成人和儿童青霉素敏感株分别占92.2%和85.1%。大肠埃希菌、克雷伯菌属超广谱β-内酰胺酶(ESBL)检出率为32.0%和20.2%,肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,耐药率均低于6%。在非发酵菌中耐亚胺培南的铜绿假单胞菌和鲍曼不动杆菌的检出率分别为12.8%和64.5%,不动杆菌对替加环素的耐药率为3.9%。结论该院近5年来的细菌耐药情况较平稳,但碳青霉烯类耐药的肠杆菌科细菌仍有上升趋势,应引起重视,进一步采取有效的感控措施,控制耐药菌株在医院的传播。

Objective To investigate the distribution and antibiotic resistance profile of clinical isolates in the first hospital of qiqihaer from 2015 to 2019.Methods Antimicrobial susceptibility test was carried out for the clinical isolates according to an agreed protocol using Kirby-Bauer method and automate system.The results were analyzed with WHONET 5.6 software according to the Clinical and Laboratory Standards Instiute CLSI 2018 breakpoints.Results A total of 19497 Nonduplicate clinical isolates were collected from 2015 to 2019,of which gram positive cocci and gram negative rodsaccounted for26.7%and73.3%,respectively.Klebsiella spp was the most frequently isolated bacteria,followed by Escherichia coli,Staphylococcus aureus,Pseudomonas aeruginosa,and Acinetobacter spp,accounting for 19.4%,17.7%,14.1%,12.3%and 8.0%,respectively.About 24.3%of the Staphylococcus aureus isolates were identified as MRSA,76.9%of the coagulase negative Staphyococcus isolates were identified as MRCNS.No Staphylococcal strain was resistant to linezolid or vancomycin.The resistance rate of Enterococcus faecium to most antibiotics was significantly higher than that of Enterococcus faecalis.A total of 9 strains of Enterococcus faecium and Enterococcus faecalis were detected to be resistant to vancomycin..A total of 514 strains of the non-meningitis S.pneumoniae were tested,45.1%of which were isolated from adults and 54.9%from children.As for the non-meningitis S.pneumoniae,the prevalence of PSSP was 85.1%in the isolates from children and 92.2%in the isolates from adults.The prevalence of ESBLs-producing strains in Escheria coli and Klebsiella spp was 32.0%and 20.2%respectively.Enterobacteriaceae is still highly sensitive to carbapenems,and the resistance rate is lower than 6%.The prevalence of imipenem-resistant Acinetobacter baumannii was 64.5%.The prevalence of imipenem-resistant Pseudomonas aeruginosa was 12.8%.The resistance rate of Acinetobacter spp.to tigecycline was 3.9%.Conclusions In the past five years,the resistance of bacteria in this hospital has been relatively stable,but the resistance of Enterobacteriaceae to carbapenems is still on the rise,so we should pay attention to it,and further take effective measures to control the spread of drug-resistant strains in the hospital.