某院多重耐药菌菌群分布及耐药性分析

Distribution and drug resistance of multi-drug resistant bacteria in a hospital

目的分析本院2014年5月至2015年4月多重耐药菌菌群分布及耐药性,为临床抗感染治疗提供理论依据。方法采用法国梅里埃公司生产的Vitek-32型微生物自动分析仪及其配套的鉴定卡进行菌株分离与鉴定,并进行药敏试验,分析多重耐药菌株的来源、菌群分布及其耐药性。结果共分离多重耐药菌株624株,其中甲氧西林凝固酶阴性葡萄球菌(MRCNS)293株、耐碳青霉烯鲍曼不动杆菌(CRABA)71株、大肠埃希菌(E.coli)57株、肺炎克雷伯菌(KNP)38株、金黄色葡萄球菌(MRSA)34株、耐碳青霉烯铜绿假单胞菌(CRPAE)27株、耐万古霉素肠球菌(VRSE2株以及奇异变形杆菌(PM)2株。阳性球菌中以MRCNS多重耐药所占比例最高(占77.7%),其次为MRSA(占55.7%)、VRSE最低(占4.5%);阴性杆菌中E.coli多重耐药最为显著(占68.6%),其次为CRABA(65.1%)、CRPAE(21.3%)和PM(13.3%)耐药均不显著。耐甲氧西林的葡萄球菌中,MRCNS对环丙沙星(CIP)、庆大霉素(GEN)、青霉素(PEN)、克林霉素(CLI)、米诺环素(MNO)和左氧氟沙星(LVX)的耐药性均显著高于MRSA(χ2=27.210、77.496、17.341、26.098、10.882、32.475,P均<0.001);E.coli、KNP和PM等对亚胺培南(IPM)均100%敏感,对阿米卡星(AMK)、头孢西丁(FOX)和头孢哌酮-舒巴坦(CSL)敏感性也较高;CRPAE与CRABA仅对哌拉西林(PIP)和CSL的耐药率低,对其他抗菌药物耐药性较强。结论临床多重耐药菌感染发生率日益升高,且耐药机制越来越复杂,导致抗感染疗效受到很大限制。

Objective To investigate the distribution and drug resistance of multi-drug resistant bacteria and to provide theoretical basis for clinical anti-infection treatment.MethodsBacteria were isolated and identificated by the French bio-Merieux company production of VITEK-32 microbial analyzer, the identiifcation card and drug sensitivity test were implemented, and then the distribution and drug resistance of the strains of multi-drug resistant were analyzed, respectively.Results Among the 624 strains of multi-drug resistant, 293 strains were MRCNS, 71 strains were CRABA, 57 strains wereE. coli, 38 strains were KNP, 34 strains were MRSA, 27 strains were CRPAE, 2 strains were VRSE and 2 strains were PM. Multi-drug resistant of MRCNS showed the highest resistance (77.7%), followed by MRSA (55.7%) and VRSE with the lowest resistance (4.5%). WhileE. coli showed the highest resistance (68.6%), followed by CRABA (65.1%), CRPAE (21.3%) and PM (13.3%) with the negativebacilli. In the methicillin resistant Staphylococcus aureus, drug resistance of MRCNS to CIP, GEN, PEN, CLI, MNO and LVX were signiifcantly higher than those of MRSA (χ2= 27.210, 77.496, 17.341, 26.098, 10.882 and 32.475; allP < 0.001). The sensitivity of E. coli to KNP, PM and IPM were all 100%, which were also high to AMK, FOX and CSL; the resistance of CRPAE and CRABA were only low to PIP and CSL, but significantly resistant to other antimicrobial agents.Conclusions With the increasing of multi-drug resistant bacteria infection and more complex for the mechanism of drug resistance, the effect of anti-infection was limited.