2014—2019年齐齐哈尔市第一医院老年患者临床分离菌耐药性监测

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

目的了解2014—2019年齐齐哈尔市第一医院老年患者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敏感性试验,按照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软件统计分析。结果共收集老年临床分离菌10965株,其中革兰阳性菌占23.22%;革兰阴性杆菌占76.78%。排名前5位的细菌为大肠埃希菌19.49%、克雷伯菌属16.04%、铜绿假单胞菌13.71%、不动杆菌属10.93%和金黄色葡萄球菌10.63%。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为34.1%、72.4%,MRSA和MRCNS的耐药率显著高于甲氧西林敏感株(MSSA和MSCNS),未发现万古霉素和利奈唑胺耐药株。肠球菌属中粪肠球菌和屎肠球菌各占53.0%和44.5%,屎肠球菌对多数抗菌药物耐药率显著高于粪肠球菌,有6株肠球菌对万古霉素耐药。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌中ESBLs的检出率分别为35.2%、25.7%和28.4%。肠杆菌目细菌对碳青霉烯类抗生素仍高度敏感,耐药率低于10.0%。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为22.4%和73.7%。结论多重耐药菌株在老年患者中的感染形势严峻,对抗感染治疗构成严重威胁,应重视细菌耐药监测并采取有效措施控制院内感染。

Objective To investigate the susceptibility and resistance of clinical bacterial isolates from geriatric patients in the first hospital of Qiqihaer during 2014—2019,To provide reference for the rational use of antibiotics.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 10965 strains of elderly clinical isolates were collected,of which gram-positive bacteria accounted for 23.22%;gram-negative Sex bacilli accounted for 76.78%.The top 5 bacteria are Escherichia coli 19.49%,Klebsiella 16.04%,Pseudomonas aeruginosa 13.71%,Acinetobacter 10.93%and Staphylococcus aureus 10.63%.About 34.1%of the Staphylococcus aureus isolates were identified as MRSA,72.4%of the coagulase negative Staphyococcus isolates were identified as MRCNS,with a decreasing trend year by year.MRSA and MRCNS showed much higher resistance rates to most of the antimicrobial agents than MSSA and MSCNS.No Staphylococcal strain was resistant to vancomycin or linezolid.Of the enterococcal isolates,E.faecalis and E.faecium accounted for 53.0%and 44.5%,respectively.The resistance rate of Enterococcus faecium to most antibiotics was significantly higher than that of Enterococcus faecalis.6 strains of Enterococcus faecium and Enterococcus faecalis were resistant to vancomycin.The prevalence of ESBL were 35.2%,25.7%and 25.4%in E.coli,K.pneumoniae,and P.mirabilis,respectively.Enterobacteriaceae strains were still highly susceptible to carbapenems,less than 10%of these strains were resistant to carbapenems.The prevalence of imipenem-resistant strains was 22.4%in P.aeruginosa and 73.7%in A.baumannii.A.baumannii isolates showed lower resistance rate to tigecycline 5.2%.Conclusions Multi-drug-resistant bacterial strains pose a serious threat in geriatric patients.It is necessary to pay more attention to surveillance of antimicrobial resistance and take effective measures to control hospital infections.