| 李光灿,王红苹,程林,等.2017—2019年重庆某三甲医院细菌耐药监测分析[J].安徽医药,2022,26(7):1474-1479. |
| 2017—2019年重庆某三甲医院细菌耐药监测分析 |
| Monitoring and analysis of bacterial resistance in a tertiary hospital in Chongqing from 2017 to 2019 |
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| DOI：10.3969/j.issn.1009-6469.2022.07.047 |
| 中文关键词: 抗药性，细菌 抗药性，多种，细菌 抗菌药 鲍曼不动杆菌 铜绿假单胞菌 哌拉西林 合理用药 |
| 英文关键词: Drug resistance, bacterial Drug resistance, multiple, bacterial Antibacterial agents Acinetobacter baumannii Pseudomonas aeruginosa Piperacillin Rational drug use |
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| 摘要点击次数: 903 |
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| 中文摘要: |
| 目的了解某三甲医院病原菌的临床分布及耐药性，为临床合理使用抗菌药物提供参考依据。方法对 2017年 1月至 2019年 12月重庆市开州人民医院临床分离病原菌采用纸片扩散法( K-B)或最低抑菌浓度法( MIC)进行药敏试验，按 CLSI 2017年版标准判读药敏试验结果，采用 WHONET 5.6软件进行数据分析。结果 9 250株分离病原菌的标本类型主要包括痰液 61.15%、尿液 13.95%、脓液 11.65%和血液 10.46%。检出科室主要为儿科、呼吸科、重症医学科( ICU)和泌尿科。其中革兰阴性菌 6 213株( 67.17%)革兰阳性菌 2 796株( 30.23%)。排名前 5位的病原菌分别为大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、铜绿假单胞菌及肺炎，链球菌。共检出多重耐药菌( MDRO)2 722株( 29.43%)检出率逐年下降。排名前 4位的 MDRO分别为产超广谱 β内酰胺酶( ESBLs)大肠埃希菌、耐甲氧西林金黄色葡萄球菌( MRSA)，、耐碳青霉烯鲍曼不动杆菌(CRABA)及产 ESBLs肺炎克雷伯菌，其中 MRSA的检出率逐年上升。细菌耐药率结果显示，肺炎克雷伯菌耐药率明显高于大肠埃希菌，产 ESBLs菌株检出率分别为 32.51%和 48.40%。这两种细菌耐药率均 <30%的药物包括哌拉西林 /他唑巴坦、头孢哌酮 /舒巴坦、头孢吡肟、碳青霉烯类、阿米卡星、妥布霉素和米诺环素。铜绿假单胞菌对药物的耐药率均 <20%，敏感性较高。但值得注意的是，铜绿假单胞菌的检出率在 3年内翻倍增长，上升速度最快。阴沟肠杆菌和嗜麦芽窄食单胞菌的耐药率均较低。鲍曼不动杆菌除米诺环素耐药率为 17.3%外，其他药物的耐药率均 >50%，耐药问题最为严重。未检出万古霉素、利奈唑胺、替加环素耐药菌株。结论近三年来该院病原菌以革兰阴性菌为主，各病原菌检出率总体呈缓慢下降趋势，鲍曼不动杆菌耐药严重，铜绿假单胞菌耐药率明显上升，细菌耐药问题依然严峻，应持续进行细菌耐药监控，加强医院感控管理。 |
| 英文摘要: |
| Objective To investigate the clinical distribution and drug resistance of pathogenic bacteria in a tertiary hospital, to pro-vide a reference for the rational use of antibiotics in clinical practice.Methods Antimicrobial susceptibility tests were performed on pathogenic bacteria clinically isolated from the People's Hospital of Kaizhou District from January 2017 to December 2019 by the Kir-by-Bauer method (K-B) or minimum inhibitory concentration method (MIC). The drug susceptibility test results were interpreted accord-ing to the 2017 CLSI standard, and WHONET 5.6 software was used for data analysis.Results The specimen types of 9 250 isolatedpathogenic bacteria mainly included 61.15% sputum, 13.95% urine, 11.65% pus and 10.46% blood. The detected departments aremainly pediatrics, respiratory department, intensive care unit (ICU) and urology. The detected pathogenic bacteria included 6 213strains (67.17%) of gram-negative bacteria and 2 796 strains (30.23%) of gram-positive bacteria. The top 5 pathogens were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Streptococcus pneumoniae. A total of 2 722 strains (29.43%) of multidrug-resistant bacteria (MDRO) were detected, and the detection rate decreased each year. The top 4 MDROs were ex-tended-spectrum beta-lactamase-producing (ESBL) Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter baumannii (CRABA) and ESBL-producing Klebsiella pneumoniae, in which the detection rate of MRSA is in-creasing year by year. The bacterial resistance rate results showed that the resistance rate of Klebsiella pneumoniae was significantly higher than that of Escherichia coli, and the detection rates of ESBL-producing strains were 32.51% and 48.40%, respectively. Drug re-sistance rates <30% for both bacteria include piperacillin/tazobactam, cefoperazone/sulbactam, cefepime, carbapenems, amikacin, to-bramycin and minocycline. The drug resistance rate of Pseudomonas aeruginosa was less than 20%, and the sensitivity was high. How-ever, it is worth noting that the detection rate of Pseudomonas aeruginosa doubled in three years, and the rate of increase was the fast-est. The drug resistance rates of Enterobacter cloacae and Stenotrophomonas maltophilia were low. Except for the resistance rate to mi-nocycline of 17.3%, Acinetobacter baumannii was more than 50% resistant to other drugs, and the drug resistance problem was the most serious. Vancomycin-, linezolid-and tigecycline-resistant strains were not detected.Conclusions In the past three years, the patho-genic bacteria in the hospital are mainly gram-negative bacteria, and the detection rate of each pathogen has shown a slow downward trend. The drug resistance of Acinetobacter baumannii is serious, and the drug resistance rate of Pseudomonas aeruginosa is significant-ly increased. The problem of bacterial drug resistance is still serious, and it is necessary to continue to monitor bacterial resistance andstrengthen hospital infection control management. |
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