全科医学科住院患者临床分离病原菌分布及耐药性分析

Analysis of distribution and drug resistance of clinically isolated pathogens in hospitalized patients of general medicine department

目的分析2016年1月至2019年12月同济大学附属杨浦医院全科医学科住院患者临床病原菌分布及耐药性,为临床合理使用抗菌药物提供依据。方法采用Vitek MS质谱仪对分离的病原菌进行鉴定,采用纸片扩散法(K-B法)和MIC法测定其对常用抗菌药物的灵敏度并参照2019版CLSI M100-S29标准判断药敏结果,替加环素的判读参照FDA标准,头孢哌酮-舒巴坦的判读参照头孢哌酮标准;WHONET 5.6软件进行统计分析。结果13831例全科医学科住院患者排除重复菌株共检出1380株细菌,其中革兰阴性菌1058株(76.67%),革兰阳性菌322株(23.33%)。革兰阴性菌以大肠埃希菌344株(24.93%)、铜绿假单胞菌176株(12.75%)及肺炎克雷伯菌161株(11.67%)为主,革兰阳性菌中金黄色葡萄球菌96株(6.96%)检出率最高,其次为粪肠球菌80株(5.80%)。药敏结果显示:产超广谱β内酰胺酶(ESBL)的大肠埃希菌和肺炎克雷伯菌分别为60.70%和30.00%;大肠埃希菌对氨苄西林耐药率最高,为87.80%,对亚胺培南和美罗培南的耐药率分别为2.30%和2.00%,肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别为9.30%和8.40%,肠杆菌科细菌中碳青霉烯类肠杆菌科细菌(CRE)的检出率为4.40%;金黄色葡萄球菌对青霉素G耐药率最高,为95.70%,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为77.90%,未发现对万古霉素、利奈唑胺和替加环素耐药的金黄色葡萄球菌。结论全科医学科住院患者感染病原菌以阴性杆菌为主,对多种抗菌药物耐药率较高,CRE检出率呈逐年升高的趋势,应加强院感防控及抗菌药物的管理。

Objective To study the distribution and drug resistance of clinical pathogenic bacteria in hospitalized patients in the general medicine department of Yangpu hospital,from January 2016 to December 2019,so as to provide a basis for the rational clinical use of antibiotics.Methods Vitek MS mass spectrometer was used to identify the isolated pathogens,and the disk diffusion method(K-B method)and MIC method were used to determine their susceptibility to commonly used antibacterial drugs.The results of drug susceptibility were analyzed and assessed according to the 2019 version of CLSI M100-S29 standard.The interpretation of Tigecycline refers to FDA standards;WHONET 5.6 software was used to perform statistical analysis.Results A total of 1,380 strains of bacteria were detected in 13,831 hospitalized patients in general medicine departments,including 1,058(76.67%)Gram-negative bacteria and 322(23.33%)Gram-positive bacteria.Gram-negative bacteria mainly include Escherichia coli(344 strains/24.93%),Pseudomonas aeruginosa(176 strains/12.75%)and Klebsiella pneumoniae(161 strains/11.67%),among the gram-positive bacteria,Staphylococcus aureus(96 strains/6.96%)has the highest detection rate,followed by Enterococcus faecalis(80 strains/5.80%).The drug susceptibility results showed that:producing rates of extended-spectrumβ-lactamase(ESBLs)of Escherichia coli and Klebsiella pneumoniae were respectively 60.70%and 30.00%;The resistannce rate of Escherichia coli to Ampicillin was the highest(87.80%),and those to Imipenem and Meropenem were respectively 2.30%and 2.00%,the resistance rates of Klebsiella pneumoniae to Imipenem and Meropenem were 9.30%and 8.40%respectively,and the detection rate of CRE in Enterobacteriaceae was 4.40%.Staphylococcus aureus had the highest resistance rate to Penicillin G(95.70%),and the detection rate of methicillin resistant Staphylococcus aureus(MRSA)was 77.90%,no Staphylococcus aureus resistant to Vancomycin,Linezolid and Tigecycline was found.Conclusion The pathogenic bacteria in hospitalized patients of general medicine department are mainly Gram-negative bacilli,the resistance rates of which to many antimicrobial agents are relatively high.The detection rate of CRE is increasing year by year.The prevention and control of nosocomial infections and the management of antibiotics should be strengthened.