2013—2015年大肠埃希菌分布及耐药性分析

Analysis of distribution and drug resistance of Escherichia coli in 2013—2015

目的了解徐州医科大学附属医院2013—2015年临床首次分离大肠埃希菌的分布特征及对抗菌药物的耐药性变迁情况,为临床合理使用抗菌药物提供依据。方法收集2013年1月—2015年12月徐州医科大学附属医院临床首次分离的大肠埃希菌,进行鉴定及药敏分析,药敏结果判断遵循CLSI 2012指南,数据使用WHONET5.6软件分析。结果共收集大肠埃希菌2 426株,送检科室以ICU(466株,19.2%)和泌尿外科(375株,15.5%)为主,标本来源以泌尿道(733株,30.2%)、呼吸道(720株,29.7%)和血(447株,18.4%)为主。3年间,大肠埃希菌的检出率呈下降趋向:2013年为19.0%,2015为12.1%。药敏试验结果显示:3年间,大肠埃希菌对各种抗菌药的耐药性发生一定变化,对部分第三代、第四代头孢菌素耐药率呈稳定下降趋向,对头孢噻肟的耐药率由82.7%下降到60.5%、对头孢吡肟由71.1%下降到41.2%;对碳青霉烯类抗生素的耐药率稳定在3.4%~4.0%之间,对氨苄西林和哌拉西林的耐药率最高,分别为90.7%和89.6%。结论大肠埃希菌仍存在多重耐药的情况,应该持续规范抗菌药物的运用,加强对大肠埃希菌感染流行与传播的控制。

Objective To investigate the distribution and drug resistance characteristic trend of Escherichia coli in the Affiliated Hospital of Xuzhou Medical University firstly isolated clinically during 2013—2015,and to provide the reference for clinical rational using of antimicrobial agents. Methods Escherichia coli isolates firstly collected clinically were identified and the data were judged with CLSI 2012 and analyzed with WHONET 5. 6. Results A total of 2 426 isolates of Escherichia coli were collected from 2013 to 2015. The department distribution is dominated by ICU 466( 19. 2%) and Department of Urology 375( 15. 5%). The Escherichia coli positive specimens were mostly isolated from sputum 733( 30. 2%),urine 720( 29. 7%) and blood 447( 18. 4%). The prevalence of E. coli decreased with time from 19. 2% in2013 to 15. 5% in 2015. Susceptibility testing showed that during the three years,the bacterium has a certain change in the resistance of all kinds of antibiotics,the resistance rates of the bacteria to the third and the fourth generation of Cephalosporin has a stable downward trend,for example,the rate to cefotaxime decreased from 82. 7% to 60. 5% and the rate to cefepime decreased from 71. 1% to 41. 2%; the rate to carbapenem stabilizes from 3. 4% to 4. 0%; the rates to ampicillin and piperacillin are the highest( 90. 7% and 89. 6%). Conclusion The multiple drug resistance still exists in Escherichia coli in our hospital. The use of antimicrobial agents should be standardized continually and the prevalence and spread of Escherichia coli should be controlled.