2020~2021年某三甲医院细菌耐药性监测分析

Monitoring and Analysis of Bacterial Drug Resistance in a Grade A Hospital from 2020 to 2021

目的分析安徽理工大学第一附属医院2020a 1月到2021a 12月的细菌耐药监测结果,为临床合理用药提供指导。方法用全自动微生物分析仪及E-Test试纸条对送检菌株进行鉴定及药敏试验,数据用WHONET 5.6软件分析。结果共收集2020~2021a的临床分离株2110株,其中革兰阳性菌727株(34.5%),革兰阴性菌1383株(65.5%)。分离的前5位病原菌为:大肠埃希菌566株(26.8%),金黄色葡萄球菌371株(17.6%),肺炎克雷伯菌249株(11.8%),铜绿假单胞菌182株(8.6%)及阴沟肠杆菌91株(8.6%)。葡萄球菌属中耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)的分离率为30.5%,耐甲氧西林凝固酶阴性葡萄球菌(Methicillin-resistant coagulase-negative Staphylococci,MRCNS)的分离率为76.7%。肠球菌属中粪肠球菌62株(44.0%),屎肠球菌79株(56.0%),屎肠球菌对苄西林和环丙沙星高度耐药。肠杆科细菌对抗菌组合药物的耐药率在3.3%~23.0%。肠杆菌目细菌中对碳青霉烯耐药的检出率排前3位的依次为鲍曼不动杆菌23株(11.8%)、肺炎克雷伯菌27株(10.8%)和铜绿假单胞菌23株(8.3%)。结论临床感染中革兰阴性菌检出率最高,细菌耐药监测结果为临床合理用药提供依据,是提高病原菌治愈、降低医疗成本和控制院内感染的有效措施。

Objective To analyze the monitoring results of bacterial drug resistance in the First Affiliated Hospital of Anhui University of Science and Technology from January 2020 to December 2021,so as to provide guidance for clinical rational drug use.Methods The strains were identified by automatic microbiological analyzer and E-test strip,and the data were analyzed by WHONET 5.6 software.Results A total of 2110 clinical isolates were collected from 2020 to 2021,including 727 Gram-positive bacterias(34.5%)and 1383 Gram-negative bacterias(65.5%).The top five pathogens were Escherichia coli(566 strains,26.8%),Staphylococcus aureus(371 strains,17.6%),Klebsiella pneumoniae(249 strains,11.8%),Pseudomonas aeruginosa(182 strains,8.6%)and Enterobacter cloacae(91 strains,8.6%).The isolation rates of methicillin resistant Staphylococcus aureus(MRSA)and methicillin resistant coagulase negative staphylococcus(MRCNS)in Staphylococcus were 30.5%and 76.7%respectively.Enterococcus included 62 strains(44.0%)of Enterococcus faecalis and 79 strains(56.0%)of Enterococcus faecium,among which enterococcus faecium was highly resistant to benzylpenicillin and ciprofloxacin.The resistance rate of Enterobacteriaceae to antibacterial combination drugs ranged from 3.3%to 23.0%.Among Enterobacteriaceae,the top three detection rates of carbapenem resistance were Acinetobacter baumannii(23 strains,11.8%),Klebsiella pneumoniae(27 strains,10.8%)and Pseudomonas aeruginosa(23 strains,8.3%).Conclusion The detection rate of Gram-negative bacteria in clinical infection is the highest.The results of bacterial drug resistance monitoring can provide the basis for clinical rational drug use,which is an effective measure to improve the cure of pathogens,reduce medical costs and control hospital acquired infection.