2018-2020年医院临床分离菌分布特征及耐药情况分析

Analysis of distribution characteristics and drug resistance of clinical isolates in the hospital from 2018 to 2020

目的了解医院2018-2020年临床分离菌的分布情况及对常用抗菌药物的耐药情况,为临床合理使用抗菌药物提供依据。方法收集该院2018年1月至2020年12月临床分离细菌,采用VITEK2-Compact全自动细菌鉴定药敏仪或纸片扩散法进行抗菌药物的灵敏度试验,按照2020年美国临床和实验室标准化协会推荐的药敏试验方法进行结果判定。数据统计分析采用WHONET 5.6软件。结果2018年至2020年共分离细菌株,其中革兰阳性菌646株(28.8%),革兰阴性菌1595株(71.2%)。耐甲氧西林金黄色葡萄球菌检出率为56.4%,粪肠球菌对多数抗菌药物的耐药性低于屎肠球菌,未发现对万古霉素的耐药的粪肠球菌,但是发现2株耐万古霉素的屎肠球菌。这3年,耐碳青霉烯铜绿假单胞菌、耐碳青霉烯大肠埃希菌耐药菌的检出率呈稳定趋势,耐碳青霉烯肺炎克雷伯菌检出率呈逐年上升趋势,耐碳青霉烯鲍曼不动杆菌的检出率呈现逐年下降趋势。结论医院耐碳青霉烯肺炎克雷伯菌检出率较高,细菌耐药性形势已较为严峻,应加强抗菌药物的合理使用和感控措施,同时应做好细菌耐药监测工作。

Objective To investigate the distribution and drug resistance of clinical isolates in the hospital from 2018 to 2020.Methods The clinical isolates were collected from Jan 2018 to Dec 2020.The VITEK 2-compact automatic bacterial detection system or disc diffusion method was used for drug susceptibility test.The drug susceptibility results were judged based on the 2020 version of the US Clinical Laboratory Standards Institute standard and the data were analyzed using the WHONET 5.6 software.Results A total of pathogens were isolated during 2018 to 2020,including646(28.8%)Gram-positive bacteria and 1595(71.2%)Gram-negative bacteria.The detection rate of methicillin-resistant Staphylococcus aureus was 56.4%.Enterococcus faecium is more resistant to most antibacterial drugs than Enterococcus faecalis.No Enterococcus faecalis resistant to vancomycin was found.But two strain of Enterococcus faecium was found to be resistant to vancomycin.During the past three years,the resistance rate of CRPA and CRECO showed a stable trend,the resistance rate of CRKPN increased year by year,the resistance rate of CRABA is on a downward trend.Conclusion The resistance rate of Klebsiellapneumoniae to carbapenems increased year by year,the situation of bacterial resistance in this hospital has become severe,the rational use of antimicrobials and infection control measures should be strengthened and the monitoring of bacterial resistance should be done well.