黑龙江省西部地区2016—2020年细菌耐药性监测

Surveillance of Antibiotic Resistance in Bacterial Isolates from the Western Region of Heilongjiang Province from 2016 to 2020

目的 了解黑龙江省西部地区2016—2020年临床分离菌对常见抗菌药物的敏感性和耐药性,为临床合理使用抗菌药物提供依据。方法 采用K-B法、自动化仪器和E试验法对分离菌进行药敏试验,依据美国临床和实验室标准化委员会(CLSI)标准判读结果,使用WHONET 5.6进行分析。结果 黑龙江西部地区6所医院共分离细菌78 516株,其中革兰阳性菌26 016株,占33.1%,革兰阴性菌52 500株,占66.9%。前5位分离菌分别为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌和鲍曼不动杆菌所占比例分别为16.6%、14.1%、13.4%、11.4%和7.7%。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)检出率有所下降(分别从24.9%、75.6%降至13.5%、54.8%)。肺炎克雷伯菌中碳青霉烯耐药株由2.9%上升至6.9%。鲍曼不动杆菌对大多数抗菌药物的耐药率接近60%。铜绿假单胞菌对亚胺培南的耐药率有下降趋势,由30.2%降至20.7%。肠球菌属中粪肠球菌和屎肠球菌各占68.9%和29.1%,屎肠球菌对多数抗菌药物耐药率显著高于粪肠球菌,屎肠球菌对万古霉素的耐药率由2016年的1.5%上升到2020年的8.8%。结论 常见病原菌以革兰阴性杆菌为主,碳青霉烯耐药的肠杆菌科细菌和鲍曼不动杆菌持续上升,应继续加强细菌耐药性监测调查,为临床合理选择用药提供参考依据。

Objective To understand the sensitivity and drug resistance of clinical isolates to common antibiotics in the western region of Heilongjiang Province from 2016 to 2020,so as to provide basis for rational clinical use of antibiotics.Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method,automated systems and E-test method.The results were analyzed with WHONET 5.6 software according to the Clinical and Laboratory Standards Instiute CLSI breakpoints.Results A total of 78516 strains of bacteria were isolated from 6 hospitals in the Western Region of Heilongjiang Province,of which 33.1% were gram-positive cocci and 66.9% were gram-negative bacilli.The top five bacterial species were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Staphylococcus aureus and Acinetobacter spp accounting for 16.6%,14.1%,13.4%,11.4% and 7.7%,respectively.Isolation rate of methicillin-resistant Staphylococcus aureus(MRSA) and methicillin-resistant coagulase negative Staphylococcus(MRCNS) decreased from 24.9% to 75.6% and 13.5% to 54.8% respectively.The carbapenem-resistant strains of Klebsiella pneumoniae rose from 2.9% to 6.9%.The percentage of the A.baumannii resistant to the commonly used antibiotics was close to or higher than 60%.Resistance rate Pseudomonas aeruginosa to imipenem decreased from 30.2% to 20.7%.E.faecalis and E.faecium accounted for 68.9% and 29.1%,respectively.The resistance rate of Enterococcus faecium to most antibiotics was significantly higher than that of Enterococcus faecalis.The resistance rate of Enterococcus faecium to vancomycin increased from 1.5% in 2016 to 8.8% in 2020.Conclusions Gram-negative bacilli are the most common clinical pathogens,the rate of carbapenem-resistant Enterobacteriaceae and A.baumannii are still on the rise.The monitoring and investigation of bacterial resistance should continue to be strengthened to provide a reference for the rational selection of drugs in clinical practice.