四川省细菌耐药监测网2014年细菌耐药监测数据分析

发布时间：2018-06-01 14:37

本文选题：细菌耐药性监测 + 耐药率　；参考：《中国抗生素杂志》2016年08期

【摘要】：目的对四川省细菌耐药监测网成员单位2014年度细菌分布及耐药情况进行统计分析,为本省临床合理应用抗菌药物提供依据。方法各成员单位临床分离菌,采用标准纸片扩散法或自动化仪器检测法,按照统一技术方案测定监测药物对细菌的敏感性,依据CLSI2014年标准,用WHONET 5.6软件进行数据分析。结果共有71家医院参加了2014年度细菌耐药监测工作,其中数据基本合格纳入分析的共69家。按患者首次分离菌株进行统计分析,共收集细菌134681株,其中革兰阴性菌99054株(73.5%),革兰阳性菌35627株(26.5%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为26.0%和82.1%,MRSA自2011年起呈下降趋势,未发现万古霉素、利奈唑胺不敏感的葡萄球菌。万古霉素耐药粪肠球菌和屎肠球菌分别占0.7%和4.2%,利奈唑胺耐药粪肠球菌和屎肠球菌分别占1.9%和0.7%。按非颅内感染的折点判断,青霉素耐药的肺炎链球菌比例为2.8%,化脓性链球菌主要对大环内酯类、克林霉素耐药,耐药率均超过55.0%。革兰阴性菌中分离率前3位分别为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌,分别为29965株(30.3%)、18508株(18.7%)和12170株(9.0%)。大肠埃希菌耐药比较突出,对喹诺酮类耐药率在55.0%以上,对第三代头孢菌素中的头孢噻肟和头孢曲松的耐药率自2012年起呈下降趋势,肠杆菌科细菌对碳青霉烯类抗菌药物总耐药率虽低于10.0%,但耐药率自2011年起有逐渐上升趋势。铜绿假单胞菌对碳青霉烯类、氨基糖苷类、哌拉西林/三唑巴坦、多黏菌素B、头孢吡肟、头孢哌酮/舒巴坦、头孢他啶的耐药率低于15.0%,耐碳青霉烯类铜绿假单胞菌比例自2012年起有所下降;鲍曼不动杆菌对包括碳青霉烯类在内的大多数监测药物耐药率超过50.0%,亚胺培南和美罗培南的耐药率分别为60.8%和59.3%,自2011年开始呈明显上升趋势。结论我省细菌耐药仍呈增长趋势,多重耐药和广泛耐药菌株检出率的增加对临床治疗造成严重威胁,应充分利用本地细菌耐药监测结果进行感控管理,促进抗菌药物合理应用。
[Abstract]:Objective to analyze the distribution and drug resistance of bacteria in Sichuan bacterial resistance monitoring network in 2014 so as to provide a basis for rational clinical use of antimicrobial agents in Sichuan Province. Methods the clinical isolates of bacteria were detected by standard disk diffusion method or automatic instrument method. The sensitivity of the drug to bacteria was determined according to the unified technical scheme. The data were analyzed by WHONET 5.6 software according to the CLSI2014 year standard. Results A total of 71 hospitals participated in the surveillance of bacterial drug resistance in 2014, of which 69 were basically qualified to be included in the analysis. A total of 134681 strains of Gram-negative bacteria were collected according to the statistical analysis of the first isolated strains. Among them, 99054 strains of Gram-negative bacteria and 35627 strains of Gram-positive bacteria were collected, and 99054 strains of Gram-negative bacteria and 35627 strains of Gram-positive bacteria were collected. The detection rates of MRSA and MRCNSwere 26.0% and 82.1%, respectively. There were no vancomycin and linazolamide insensitive staphylococci. Vancomycin-resistant Enterococcus faecalis and Enterococcus faecium accounted for 0.7% and 4.2%, respectively, and linazolamine resistant Enterococcus faecalis and Enterococcus faecium accounted for 1.9% and 0.7%, respectively. The percentage of penicillin resistant Streptococcus pneumoniae was 2.8, and Streptococcus pyogenes was mainly resistant to macrolides and clindamycin. The drug resistance rate of penicillin resistant Streptococcus pneumoniae was more than 55.0%. Among Gram-negative bacteria, the first three were Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, which were 29965 strains and 18508 strains, respectively. The resistance rate of Escherichia coli to quinolones was more than 55.0%, and the resistance to cefotaxime and ceftriaxone in the third generation cephalosporins showed a decreasing trend since 2012. Although the total resistance rate of Enterobacteriaceae to carbapenems was lower than 10.0, the resistance rate of Enterobacteriaceae increased gradually since 2011. Pseudomonas aeruginosa against carbapenems, aminoglycosides, piperacillin / triazobactam, polymyxin B, cefepime, cefoperazone / sulbactam, The resistance rate of ceftazidime was lower than 15.0. The percentage of carbapene-resistant Pseudomonas aeruginosa had decreased since 2012. The resistance rate of Acinetobacter baumannii to most drugs including carbapenem was more than 50.0%. The resistance rates of imipenem and meropenem were 60.8% and 59.3% respectively. The drug resistance rates of Acinetobacter baumannii and meropenem were 60.8% and 59.3% respectively. Conclusion bacterial drug resistance is still on the increase in our province. The increase of the detection rate of multidrug resistance and extensive drug resistance strains poses a serious threat to clinical treatment. It is necessary to make full use of the monitoring results of local bacterial drug resistance to manage sensitively and to promote the rational use of antimicrobial agents.
【作者单位】：四川省医学科学院·四川省人民医院检验科;
【分类号】：R446.5

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