2005—2014年华中科技大学同济医学院附属同济医院细菌耐药性监测

发布时间：2018-05-05 22:25

本文选题：细菌耐药性监测 + 抗菌药物　；参考：《中国感染与化疗杂志》2016年02期

【摘要】：目的分析武汉同济医院2005年1月—2014年12月临床分离细菌分布及其对常用抗菌药物耐药性变迁。方法采用纸片扩散法(K-B法)进行抗菌药物敏感性试验,E试验检测青霉素和头孢曲松对肺炎链球菌及万古霉素对葡萄球菌属的MIC。结果 10年间共获得非重复临床分离菌株56 205株,其中革兰阴性菌38 628株,占68.7%,革兰阳性菌17 577株,占31.3%。排名前5位的分离菌分别为大肠埃希菌、不动杆菌属、金黄色葡萄球菌(金葡菌)、克雷伯菌属和铜绿假单胞菌。10年间不动杆菌属分离率呈现逐年升高趋势,凝固酶阴性葡萄球菌呈现逐年下降趋势。甲氧西林耐药金葡菌(MRSA)和甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)的平均检出率分别为64.7%和79.8%,有逐年增高趋势。粪肠球菌在10年间维持对氨苄西林、青霉素、万古霉素、替考拉宁、利奈唑胺、高浓度庆大霉素、左氧氟沙星较高敏感率,而屎肠球菌对多种抗菌药物耐药率高,并呈现耐药率增高趋势,仅对万古霉素、替考拉宁、利奈唑胺耐药率较低。10年来,大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)、奇异变形杆菌中产ESBL菌株的比例呈逐年增长趋势,产ESBL菌株对检测抗菌药物敏感率均低于非产ESBL菌株。碳青霉烯类耐药的肠杆菌科细菌(CRE)近年增长显著。不发酵糖革兰阴性杆菌中不动杆菌属分离率逐渐增加并成为医院感染最常见的菌种,不动杆菌属对多种检测抗菌药物耐药率呈逐年上升趋势,而铜绿假单胞菌对测试抗菌药物仍保持较高的敏感率。结论细菌耐药性监测10年间,多重耐药菌分离率呈上升趋势,且多数临床分离菌也呈增长趋势,给临床治疗带来一定挑战。
[Abstract]:Objective to analyze the distribution of clinical bacteria isolated from Wuhan Tongji Hospital from January 2005 to December 2014 and the change of antimicrobial resistance to common antibiotics. Methods the susceptibility test of penicillin and ceftriaxone to Streptococcus pneumoniae and vancomycin to Staphylococcus was carried out by disk diffusion method (K-B method). Results A total of 56,205 non-repeated clinical isolates were obtained in the past 10 years, of which 38,628 were Gram-negative bacteria (68.7%) and 17,577 were Gram-positive bacteria (31.333%). The first five isolates were Escherichia coli, Acinetobacter, Staphylococcus aureus (Staphylococcus aureus, Klebsiella and Pseudomonas aeruginosa). Coagulase negative staphylococcus showed a decreasing trend year by year. The average detection rates of MRSA and MRCNS were 64.7% and 79.8%, respectively. Enterococcus faecalis maintained a high sensitivity to ampicillin, penicillin, vancomycin, teicoplanin, linazolamine, high concentration gentamicin, levofloxacin for 10 years, while Enterococcus faecium had high resistance to various antimicrobial agents. The resistance rate of vancomycin, teicoplanin and linazolamide was lower than that of vancomycin, teicoplanin and linazolamide. The proportion of ESBL producing strains in Klebsiella pneumoniae and Klebsiella acidogenic bacteria increased year by year, and the susceptibility of ESBL producing strains to the detection of antimicrobial agents was lower than that of non ESBL producing strains. Carbapenem resistant Enterobacteriaceae (CRE) has increased significantly in recent years. The isolation rate of Acinetobacter from non-fermentative glycosylgram-negative bacilli increased gradually and became the most common strain of nosocomial infection. The resistance rate of Acinetobacter to various antimicrobial agents increased year by year. Pseudomonas aeruginosa remained high sensitivity to antimicrobial test. Conclusion during the 10 years of bacterial resistance monitoring, the isolation rate of multidrug resistant bacteria is on the rise, and the majority of clinical isolates are also increasing, which brings some challenges to the clinical treatment.
【作者单位】：华中科技大学同济医学院附属同济医院检验科;
【分类号】：R446.5

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