| 余建洪,张肃川,徐雪梅,等.2017年某医院细菌耐药性监测的分析[J].安徽医药,2020,24(3):467-472. |
| 2017年某医院细菌耐药性监测的分析 |
| Monitoring and analysis of bacterial resistance in a hospital in 2017 |
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| DOI：10.3969/j.issn.1009?6469.2020.03.012 |
| 中文关键词: 微生物敏感性试验 抗药性，细菌 抗药性，多种，细菌 β内酰胺酶类 氨基糖苷类 革兰氏阴性菌 革兰氏阳性菌 万古霉素 青霉素类 |
| 英文关键词: Microbial sensitivity tests Drug resistance,bacterial Drug resistance,multiple,bacterial beta?Lactamases Aminoglycosides Gram?negative bacteria Gram?positive bacteria Vancomycin Penicillins |
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| 中文摘要: |
| 目的了解某医院临床分离细菌的分布特点及耐药情况，为临床合理使用抗菌药物提供参考。方法收集 2017年全年自贡市第一人民医院微生物室分离的临床菌株及药敏结果，采用 WHONET 5.6软件对数据进行分析统计。结果 2017年共分离出细菌 3 679株，其中革兰阳性菌 1 033株，占 28.1%，革兰阴性菌 2 646株，占 71.9%。分离菌中排名前 5位的细菌分别是大肠埃希菌( 26.7%)、金黄色葡萄球菌( 10.6%)、肺炎克雷伯菌( 10.6%)、铜绿假单胞菌( 9.2%)和肺炎链球菌( 7.0%)。标本类型以痰液和尿液为主，其中痰液以铜绿假单胞菌和肺炎克雷伯菌为主，而尿液以大肠埃希菌和肺炎克雷伯菌为主。分离细菌最多的科室为儿科，占 17.6%，其次是普通外科( 9.3%)和泌尿外科( 6.6%)，儿科以金黄色葡萄球菌和肺炎链球菌为主，而普通外科和泌尿外科均以大肠埃希菌为首位。常见革兰阳性菌耐药监测结果为:未分离出耐万古霉素、利奈唑胺或奎奴普丁 /达福普汀的金黄色葡萄球菌和肺炎链球菌，其中耐甲氧西林金黄色葡萄球菌( MRSA)的检出率为 19.9%，而耐青霉素肺炎链球菌的检出率为 0%。而肠球菌中屎肠球菌较粪肠球菌对常见抗菌药物耐药率更高(除外四环素和利奈唑胺)，两者对万古霉素和利奈唑胺的耐药率均较低(＜ 4.0%)其中粪肠球菌对万古霉素耐药率为 0%。常见革兰阴性菌耐药结果为:大肠埃希菌和肺炎克雷伯菌对头孢吡肟、哌拉西林 /他唑巴，坦、碳青霉烯类及氨基糖苷类耐药率均较低(＜ 10%)，其中产超广谱 β?内酰胺酶( ESBL)的菌株分别占 43.3%和 20.8%，且产 ESBL菌株较不产 ESBL菌株对常见抗菌药物耐药率高；而铜绿假单胞菌对常见抗菌药物耐药率较低，对左氧氟沙星、庆大霉素、妥布霉素、阿米卡星敏感率均为 90%以上。结论临床分离菌以革兰阴性菌为主。不同科室及标本类型的常见分离菌的差异较大，临床应根据病原菌的分布特点及耐药性合理选择抗菌药物。 |
| 英文摘要: |
| Objective To understand the distribution and drug resistance of clinical isolates in a hospital，and to provide reference for the rational use of antimicrobial agents.Methods The clinical strains isolated from the microbiology laboratory of Zigong First people’s Hospital in 2017，and the results of drug sensitivity were collected.The data were analyzed by WHONET 5.6 software. Results A total of 3 679 strains of bacteria were isolated in 2017，of which 1 033 were Gram?positive bacteria(28.1%)and 2 646 Gram?negative bacteria(71.9%).The top five isolates were Escherichia coli(26.7%)，Staphylococcus aureus(10.6%)，Klebsi? ella pneumoniae(10.6%)，Pseudomonas aeruginosa(9.2%)and Klebsiella pneumoniae(7.0%).Pseudomonas aeruginosa and Kleb? siella pneumoniae were the main bacteria isolated in sputum，while Escherichia coli and Klebsiella pneumoniae in urine.The most isolated germs were paediatrics(17.6%)，followed by general surgery(9.3%)and urology(6.6%).Staphylococcus aureus and Strep? tococcus pneumoniae were the main bacteria isolated in pediatrics，while Escherichia coli was the first isolated bacteria in generalsurgery and urology.The results of drug resistance surveillance of common gram?positive bacteria were as follows:vancomycin resis?tant Staphylococcus aureus and Streptococcus pneumoniae were not isolated.The detection rate of methicillin?resistant Staphylococ? cus aureus(MRSA)was 19.9% and penicillin resistant Streptococcus pneumoniae was 0%.The resistance rate of Enterococcus fae?cium to common antimicrobial agents was higher than that of Enterococcus faecalis(except tetracycline and linazolamide)，and the resistance rates of both to vancomycin and linazolamine were lower(＜ 4.0%)，while that of Enterococcus faecium was higher than that of Enterococcus faecalis(except tetracycline and linazolamide).The resistance rate of Enterococcus faecalis to vancomycin was0%.The results of drug resistance of common Gram?negative bacteria were as follows:The resistance rates of Escherichia coli and Klebsiella pneumoniae to cefepime，piperacillin / tazobactam，carbendene and aminoglycoside were low(＜ 10%)， the extended? spectrum β?lactamases(ESBLs)?producing strains accounted for 43.3% and 20.8%，respectively.The resistant rate of ESBLs?pro?ducing strains to common antibiotics is higher than that of non?producing ESBLs strains.And Pseudomonas aeruginosa resistancerate to common antimicrobial agents was low，and the sensitivity to levofloxacin，gentamicin，tobramycin and amikacin were over 90%.Conclusions Gram?negative bacteria are the main bacteria in clinical isolates，and there are great differences among thecommon isolates in different departments and specimen types.Antibiotics should be selected rationally according to the distributioncharacteristics and drug resistance of pathogenic bacteria in the clinic. |
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