2018-2020年某医院主要耐药菌监测分析

Surveillance and analysis of major antibiotic resistance in a hospital during 2018-2020

目的分析2018—2020年某医院临床分离主要致病菌的耐药情况,为临床抗菌药物的合理使用和医院感染控制提供参考。方法回顾并分析2018—2020年武警特色医学中心临床标本分离的主要病原菌分布及耐药性,菌种鉴定及耐药试验均使用全自动细菌鉴定药敏仪。依据2018年美国临床和实验室标准化协会(CLSI)标准判断结果,采用WHONET 5.6软件对实验结果进行统计分析。结果2018—2020年该院共检出细菌19637株,其中革兰阴性(G^(-))菌15664株(占79.8%),革兰阳性(G^(+))菌3973株(占20.2%)。每年分离株数占比为前5位的细菌均为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌、金黄色葡萄球菌(2018年分别为18.8%、16.9%、16.0%、9.8%、8.8%,2019年分别为27.2%、15.3%、16.4%、8.2%、7.5%,2020年分别为23.8%、18.4%、14.9%、11.8%、5.1%)。2018—2020年该院未检出对万古霉素和利奈唑胺耐药的葡萄球菌,主要耐药菌的检出率呈下降趋势,但仍高于2019年全国细菌耐药监测网(CARSS)统计的平均水平。结论2018—2020年该院检出的细菌耐药率趋于下降,应持续做好细菌耐药性监测工作,为临床合理使用抗菌药物,加强医院感染防控,避免耐药菌株的产生和传播提供依据。

Objective To analyze the drug resistance of main pathogenic bacteria isolated in a hospital from 2018 to 2020,and to provide the basis for rational use of antibiotics and hospital infection control.Methods The distribution and drug resistance data of main clinical specimens in Characteristic Medical Center of the Chinese People's Armed Police Force from 2018 to 2020 were retrospectively analyzed.Automatic drug sensitivity instrument was used for bacterial identification and drug resistance test.According to the standard interpretation results of Clinical and Laboratory Standards Institute(CLSI)in 2018,the results were analyzed by WHONET 5.6 software.Results A total of 19637 strains of bacteria were isolated from 2018 to 2020,including 15664 strains(79.8%)of Gram negative(G^(-))bacteria and 3973 strains(20.2%)of Gram positive(G^(+))bacteria.The top 5 bacteria isolated were Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coil,Acinetobacter baumannii and Staphylococcus aureus(18.8%,16.9%,16.0%,9.8%,8.8%in 2018;27.2%,15.3%,16.4%,8.2%,7.5%in 2019;23.8%,18.4%,14.9%,11.8%,5.1%in 2020).No vancomycin and linezolid resistant Staphylococcus was detected,among which the detectable rate of major drug-resistant bacteria showed a downward trend but was still higher than the national average level of China Antimicrobial Resistance Surveillance System(CARSS)in 2019.Conclusions The situation of bacterial resistance in the hospital is decreasing from 2018 to 2020.The monitoring of bacterial resistance should be continuously done to provide a basis for rational use of antibiotics in clinical practice,strengthening the prevention and control of hospital infection,and avoiding the widespread spread of drug-resistant strains.