3206株肠杆菌科细菌的临床分布及耐药性分析

Clinical distribution and drug resistance of 3206 strains of Enterobacteriaceae bacteria

目的了解临床分离肠杆菌科细菌的临床分布及耐药性,为临床合理使用抗菌药物提供理论依据。方法分析2014年1月至2015年6月武汉大学人民医院分离的肠杆菌科细菌分布特点及药敏结果,分离的所有肠杆菌科细菌均采用全自动细菌鉴定药敏系统BD-Phoenix-100进行鉴定。结果共检出3 206株肠杆菌科细菌,其中主要为大肠埃希菌1 821株(56.8%)、肺炎克雷伯菌652株(20.4%)、阴沟肠杆菌201株(6.3%)、产气肠杆菌104株(3.2%),肠杆菌科细菌以尿液标本分离率最高(1 666株,52.0%),其次为痰标本(463株,14.4%)和血液标本(343株,10.7%),科室分布以泌尿外科(599株,18.7%)和肾病内科(380株,11.9%)为主。肠杆菌科细菌敏感性最高的抗菌药物为亚胺培南和美罗培南,尤其是大肠埃希菌和肺炎克雷伯菌,耐药率均低于3.1%,阿米卡星和哌拉西林/他唑巴坦亦保持了良好的抗菌活性。结论肠杆菌科细菌在泌尿外科和肾病内科分布比较集中,对抗菌药物呈现不同程度的耐药,碳青霉烯类抗生素亚胺培南和美罗培南仍是最敏感的抗肠杆菌科细菌药物,但已有耐药株的出现,临床应采取有效的防控措施从而减少耐药菌株的出现和播散流行。

Objective To analyze the clinical distribution and drug resistance of Enterobacteriaceae bacteria,and to provide theoretical basis for clinical rational use of antimicrobial agents. Methods The clinical distribution and drug susceptibility results of Enterobacteriaceae bacteria isolated from Renmin Hospital of Wuhan University from January 2014 to June 2015 were analyzed. All the isolated Enterobacteriaceae bacteria were identified by automatic bacteria identification and drug susceptibility systems BD-Phoenix-100. Results A total of 3 206 strains of Enterobacteriaceae bacteria were detected, mainly including 1 821 strains(56.8%) of E. coli, 652 strains(20.4%) of Klebsiella pneumonia,201 strains(6.3%) of Enterobacter cloacae and 104 strains(3.2%) of Enterobacter aerogenes. Enterobacteriaceae bacteria were mainly isolated from urine specimens(1 666 strains, 52.0%), followed by sputum specimens(463 strains, 14.4%),blood specimens(343 strains, 10.7%). The bacteria were mainly distributed in the Department of Urology(599 strains,18.7%) and Nephrosis Internal Medicine(380 strains, 11.9%). Enterobacteriaceae bacteria showed the highest sensitivity to imipenem and meropenem, especially E.coli and Klebsiella pneumonia, with the drug resistance less than 3.1%. Amikacin and piperacillin/tazobactam also showed good antimicrobial activity. Conclusion Enterobacteriaceae bacteria were mainly distributed in the Department of Urology and Nephrosis Internal Medicine and showed different degrees of resistance to antimicrobial agents. Imipenem and meropenem were still the most sensitive drugs in the treatment of Enterobacteriaceae bacteria, in spite of the emergence of drug-resistant strains. Clinical effective prevention and control measures should be taken to reduce the emergence and dissemination of resistant strains.