摘要
目的:分析某三甲医院2016至2019年临床分离常见病原菌的分布特点和耐药性变迁。方法:回顾性分析我院上传全国细菌耐药监测网(CHINET)2016至2019年的上报数据。采用Vitek-2全自动微生物分析仪和K-B纸片扩散法进行鉴定及药敏试验,按美国临床实验室标准化协会(CLSI)2019年版标准判读药敏结果,采用WHONET5.6软件进行分析。结果:2016至2019年我院从临床共检出6369株非重复菌株,其中革兰阳性菌1334株(20.95%),革兰阴性菌5035株(79.05%)。大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌占革兰阴性菌的前4位;革兰阳性菌中检出的主要细菌是金黄色葡萄球菌。病原菌标本分布主要以痰液、尿液和血液为主。耐碳青霉烯肠杆菌科细菌(CRE)的检出率逐年上升,从2016年18.3%上升至2019年22.1%,其中肺炎克雷伯菌占比最高,对亚胺培南和美罗培南耐药率分别为35.7%和35.9%,主要分离科室为ICU。大肠埃希菌对亚胺培南和美罗培南较敏感,鲍曼不动杆菌对二者普遍耐药,而铜绿假单胞菌对亚胺培南和美罗培南的耐药率可达48.3%和38.3%。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率在17.9%~49.2%,MRSA和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)菌株对各类抗菌药物的耐药率明显高于甲氧西林敏感的金黄色葡萄球菌(MSSA)和凝固酶阴性葡萄球菌(MSCNS)菌株,目前未发现对万古霉素和替加环素耐药的葡萄球菌。粪肠球菌对大多数抗菌药物的耐药率明显低于屎肠球菌,两者对万古霉素、利奈唑胺、替考拉宁、替加环素具有较好的敏感性,屎肠球菌对万古霉素有少见的耐药情况。结论:我院临床分离的耐药菌检出率呈明显上升趋势,尤以肺炎克雷伯菌和鲍曼不动杆菌上升速度最快。随着抗菌药物应用的增加,细菌耐药广度和程度不断加大,耐药形势不容乐观,应予以高度关注。
Objective:To analyze the distribution and drug resistance changes of common pathogenic bacteria isolated from a tertiary hospital from 2016 to 2019.Methods:The data reported by our hospital to bacterial drug resistance monitoring network(CHINET)from 2016 to 2019 were retrospectively analyzed.Vitek-2 compact system and K-B method were used for identification of the strains and antimicrobial susceptibility testing.The results of antimicrobial susceptibility were interpreted according to the American association of clinical laboratory standardization institute(CLSI)2019 edition standard,and WHONET5.6 software was used to analyze the data.Results:A total of 6369 non-repeated strains were detected,of which 1334 strains were gram-positive bacteria(20.95%),5035 strains were gram-negative(79.05%).Escherichia coli(E.coli),Klebsiella pneumoniae(K.pneumoniae),Acinetobacter baumannii(A.baumannii)and Pseudomonas aeruginosa(P.aeruginosa)were the top 4 gram-negative bacteria.Staphylococcus aureus(S.aureus)was the main bacteria among gram-positive bacteria.Specimens were mainly sputum,urine and blood.The detection rate of carbapenem-resistant Enterobacteriaceae(CRE)increased year by year,from 18.3%in 2016 to 22.1%in 2019.Among them,K.pneumoniae accounted for the highest proportion,the resistant rates to imipenam and meropenam were 35.7%and 35.9%respectively,and the main separation unit was ICU.E.coli was highly sensitive to imipenam and meropenam,while A.baumannii was generally resistant to both,and the resistant rates of P.aeruginosa to imipenam and meropenam could reach 48.3%and 38.3%respectively.The detection rate of methicillin-resistant S.aureus(MRSA)was 17.9%-49.2%.The resistant rates of MRSA and methicillin-resistant coagulase-negative staphylococcus(MRCNS)were significantly higher than those of MSSA and MSCNS.No Staphylococci isolates resistant to linezolid and tigecycline were found.The resistant rate of Enterococcus faecalis was significantly lower than that of Enterococcus faecium.Both kept highly sensitive to vancomy
作者
王嵩宇
张雪云
WANG Songyu;ZHANG Xueyun(Graduate Training Base of Liaoning Provincial People's Hospital of Jinzhou Medical University,Shenyang 110001,China)
出处
《沈阳医学院学报》
2022年第1期40-45,共6页
Journal of Shenyang Medical College
关键词
细菌耐药性监测
抗菌药
多重耐药
病原菌
鲍曼不动杆菌
肺炎克雷伯菌
bacterial resistance monitoring
antibacterial drugs
multi-drug resistance
pathogenic bacteria
Acinetobacter baumannii
Klebsiella pneumoniae
