2019~2021年某三甲医院细菌耐药性分析及对抗感染治疗的意义

Analysis on drug resistance of pathogens and the significance of anti-infection treatment in a grade-A tertiary hospital from 2019 to 2021

目的了解2019~2021年临床检出细菌的分布特点及耐药性变化,为指导临床合理使用抗菌药物提供理论依据。方法收集某院各病区采集的样本,用自动化仪器检测法或标准纸片扩散法对分离菌进行药敏试验,统计分析细菌分布、构成及耐药情况。结果3年内共分离细菌5304株,其中革兰阴性菌4257株(80.3%),革兰阳性菌1047株(19.7%)。检出前5位的细菌分别为大肠埃希菌(23.1%)、克雷伯菌属(19.4%,以肺炎克雷伯菌为主)、假单胞菌属(12.4%,以铜绿假单胞菌为主)、不动杆菌属(8.2%,以鲍曼不动杆菌为主)、金黄色葡萄球菌(8.1%)。肠杆菌目细菌对碳青霉烯类药物的耐药率为2.2%,其中大肠埃希菌、肺炎克雷伯菌对该类药物的耐药率分别为1.9%、1.4%;铜绿假单胞菌(PA)对亚胺培南和美罗培南的耐药率分别为21.7%和18.1%;鲍曼不动杆菌(AB)对亚胺培南和美罗培南的耐药率分别高达58.4%和57.2%;PA和AB(2019年除外)对碳青霉烯类药物的耐药率均呈上升趋势。革兰阳性菌中以葡萄球菌属占比最高,其中耐甲氧西林金葡菌(MRSA)2019~2021年检出率依次为30.4%、29.2%、36.2%(P>0.05);甲氧西林敏感金葡菌(MSSA)对青霉素、苯唑西林、克林霉素的耐药率低于MRSA(P<0.05),但对庆大霉素、复方新诺明的耐药率高于MRSA(P<0.05);未检测出对利奈唑胺、万古霉素、替加环素、喹努普汀/达福普汀耐药的金葡菌。结论2019~2021年临床分离的细菌主要为革兰阴性菌,且对目前常用的抗菌药物有较高的耐药率,尤其是碳青霉烯类耐药菌株不断出现,合理选用抗菌药物具有重要意义。

Objective To understand the distribution and drug resistance changes of pathogens from 2019 to 2021,and to provide evidence for clinically rational use of antibacterial drugs.Methods The clinical data were collected from various samples in a hospital wards.Antimicrobial susceptibility testing was performed by automated system or Kirby-Bauer method.And the distribution,composition and drug resistance of pathogens were analyzed statistically.Results 5304 strains of pathogens were isolated in the three years,including 4257(80.3%)strains of gram-negative bacteria and 1047(19.7%)strains of gram-positive bacteria.The top five isolated pathogens were Escherichia coli(23.1%),Klebsiella spp.(19.4%,mainly Klebsiella pneumoniae),Pseudomonas spp.(12.4%,mainly Pseudomonas aeruginosa),Acinetobacter spp.(8.2%,mainly Acinetobacter baumannii)and Staphylococcus aureus(8.1%).The resistance rate of Enterobacteriaceae to carbapenems was 2.2%,among which the resistance rates of Escherichia coli and Klebsiella pneumoniae were 1.9%and 1.4%respectively;resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 21.7%and 18.1%respectively,while resistance rates of Acinetobacter baumannii to them were 58.4%and 57.2%respectively;resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii(except 2019)to carbapenems showed an upward trend.Staphylococcus spp.accounted for the highest proportion of gram-positive bacteria.The isolation rates of methicillin-resistant Staphylococcus aureus(MRSA)from 2019 to 2021 were 30.4%,29.2%and 36.2%respectively(P>0.05).The resistance rates of methicillin-sensitive Staphylococcus aureus(MSSA)to penicillin,oxacillin and clindamycin were lower than those of MRSA(P<0.05);however the rates of MSSA to gentamicin and sulfamethoxazole/trimethoprim were higher than those of MRSA(P<0.05).Staphylococcus aureus resistant to linezolid,vancomycin,tegecycline,quinupristin/dalfopristin was not isolated.Conclusion The clinical pathogens from 2019 to 2021 are mainly gram-negative bacteria,which have high resistance rates to commonly used antibacterial agents.Especially carbapenem resistant strains continue to emerge now,so it is of great significance to reasonably select antibacterial agents.