2020年沈阳市某三甲医院手外科患者的伤口及脓液标本细菌耐药分析

Antimicrobial resistance antimicrobial resistance analysis of bacteria from wound and pus specimens in Shenyang Medical College affiliated hospital hand surgery department in 2020

目的分析我院2020年手外科患者伤口、脓液标本来源细菌分布及对临床常用抗菌药物的敏感性和耐药性。方法对标本来源细菌的药敏数据进行分析,依据美国临床实验室标准化协会(CLSI)标准判读,应用WHONET 5.6软件进行药敏结果分析。结果手外科2020年共分离伤口及脓液来源细菌811株,分离前5位的细菌依次为金黄色葡萄球菌(17.6%)、铜绿假单胞菌(11.0%)、鲍曼不动杆菌(10.0%)、奇异变形杆菌(8.8%)、阴沟肠杆菌(7.3%)。葡萄球菌属中耐甲氧西林金黄色萄菌(MRSA)的检出率为12.6%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为77.8%,未发现对利奈唑胺、替考拉宁和万古霉素耐药的葡萄球菌;肠球菌属中粪肠球菌和屎肠球菌检出率较低,仅检测出15株;肠杆菌目细菌中,分离前两位的是奇异变形杆菌和阴沟肠杆菌,对四代头孢较三代头孢耐药率低,对酶抑制剂抗生素耐药性更低,对亚胺培南和厄他培南的耐药率均<3.0%。大肠埃希菌在肠杆菌目细菌中仅占第三位,对头孢菌素、喹诺酮类和复方新诺明的耐药率较高,部分耐药率甚至>85%以上,对亚胺培南和厄他培南的敏感性最高,均为100%;非发酵革兰阴性杆菌以铜绿假单胞菌(11.0%)、鲍曼不动杆菌(10.0%)最常见,在手外科伤口及脓液分离所有细菌中排名位于第二、第三位,铜绿假单胞菌的药敏结果较好,仅对替加环素的耐药率较高(>80%),其次是庆大霉素42.5%,对其他各种抗生素的耐药率均<30%。而鲍曼不动杆菌的总体耐药率要高于铜绿假单胞菌,仅米诺环素和替加环素的耐药率<25%,对其他各类抗生素的耐药率均在40~70%,分离的17株嗜麦芽窄食单胞菌,对左氧氟沙星、复方新诺明和米诺环素的耐药率均较低(<20%)。结论手外科患者伤口及脓肿感染病原菌以金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、奇异变形杆菌、阴沟肠杆菌为主,对抗菌药物的耐药率较高,应定期监测伤口及脓液来源细菌的耐药性变迁,为抗菌药物合理应用和临床经验治疗提供依据。

Objective To analyze the distribution as well as antimicrobial susceptibility and resistance of bacteria isolated from wound and pus specimens from Shenyang Medical College affiliated hospital hand surgery department in 2020.Methods Antimicrobial susceptibility testing data of bacteria from wound and pus specimens from my hospital in 2020 were analyzed,according to 2019 CLSI by WHONET 5.6 software.Results A total of 811 bacterial strains from wound and pus were isolated in 2020,the top 5 bacteria were Staphylococcus aureus(17.6%),Pseudomonas aeruginosa(11.0%),Acinetobacter baumannii(10.0%),Proteus mirabilis(8.8%)and Enterobacter cloacae(7.3%).Isolate rates of MRSA were 12.6%,MRCNS were 77.8%,For Kauranen,linezolid,and vancomycin-resistant Staphylococcus were not found.Enterococcus faecalis and Enterococcus faecium 15 strains.Resistance rates of Escherichia coli to imipenem and meropenem were 0,Resistance rates of Cephalosporin were high.Resistance rates of Pseudomonas aeruginosa were good,the resistance rate of Acinetobacter baumannii was higher,resistance rates to Stenotrophomonas maltophilia was<20%.Conclusion Pathogens isolated from wound and pus are mainly Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii,Proteus mirabilis and Enterobacter cloacae,antimicrobial resistance rate of bacteria is high,antimicrobial resistance test should be surveilled regularly.