2014年北京协和医院细菌耐药性监测

发布时间：2018-07-16 17:52

【摘要】：目的了解北京协和医院2014年临床分离细菌对抗菌药物的耐药性。方法共收集8 295株非重复分离菌,采用纸片扩散法或自动化仪器法进行药敏试验,按CLSI 2014年版标准判读药敏结果,采用WHONET 5.6软件进行数据分析。结果 8 295株细菌中,革兰阴性菌占67.4%,革兰阳性菌占32.6%。10种最常见的细菌分别为:大肠埃希菌(18.1%),铜绿假单胞菌(10.8%),肺炎克雷伯菌(10.2%),金黄色葡萄球菌(金葡菌)(9.8%),鲍曼不动杆菌(9.2%),粪肠球菌(6.3%),屎肠球菌(4.1%),凝固酶阴性葡萄球菌(4.1%),阴沟肠杆菌(3.1%)和嗜麦芽窄食单胞菌(2.9%)。耐甲氧西林金葡菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)的检出率分别为28.4%和66.5%。耐甲氧西林葡萄球菌对β内酰胺类和其他抗菌药物的耐药率明显高于甲氧西林敏感葡萄球菌。仍有81.3%MRSA对甲氧苄啶-磺胺甲VA敏感。MRCNS中有81.1%菌株对利福平敏感。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。粪肠球菌对大多数抗菌药物(除外氯霉素)的耐药率明显低于屎肠球菌。发现少数万古霉素耐药肠球菌(VRE),根据表型推测为Van A和Van B型耐药,未发现对利奈唑胺耐药的肠球菌。β溶血链球菌对青霉素的敏感率为90.8%。产ESBL的大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌的检出率分别为54.2%、31.0%和28.9%。肠杆菌科细菌对碳青霉烯类仍高度敏感,总耐药率≤3.3%。广泛耐药肺炎克雷伯菌的检出率为1.3%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为17.5%和11.8%,对阿米卡星的耐药率5.9%。鲍曼不动杆菌对上述2种碳青霉烯类抗生素的耐药率分别为69.0%和67.4%,对头孢哌酮-舒巴坦和米诺环素的耐药率低,分别为47.8%和28.7%。广泛耐药鲍曼不动杆菌和铜绿假单胞菌的检出率分别是32.3%和1.8%。流感嗜血杆菌中β内酰胺酶的检出率为33.7%。肺炎链球菌对红霉素和克林霉素的耐药率93%。结论细菌对抗菌药物的耐药率呈增长趋势,特别是碳青霉烯类耐药肠杆菌科细菌,应采取有效的医院感染控制措施和加强抗菌药物的合理使用。
[Abstract]:Objective to investigate the antimicrobial resistance of clinical bacteria isolated from Peking Union Hospital in 2014. Methods A total of 8 295 strains of non-repeated isolates were collected. Susceptibility tests were carried out by disk diffusion method or automatic instrument method. The drug sensitivity results were interpreted according to CLSI 2014 standard, and the data were analyzed by WHONET 5.6 software. Results among 8 295 strains of bacteria, The most common bacteria were Escherichia coli (18.1%), Pseudomonas aeruginosa (10.8%), Klebsiella pneumoniae (10.2%), Staphylococcus aureus (9.8%), Acinetobacter baumannii (9.2%), Enterococcus faecalis (6.3%), faecium. Enterococcus (4.1%), coagulase-negative staphylococcus (4.1%), Enterobacter cloacae (3.1%) and Staphylococcus maltophilia (2.9%). The positive rates of methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococcus (MRCNS) were 28.4% and 66.5%, respectively. The resistance rate of methicillin resistant Staphylococcus to 尾 lactams and other antimicrobial agents was significantly higher than that of methicillin sensitive Staphylococcus. There were still 81.3% of MRSA susceptible to trimethoprim sulfamethamide.81.1% of the strains were rifampicin sensitive. No staphylococci resistant to vancomycin, teicoplanin and linazolamide were found. The resistance rate of Enterococcus faecalis to most antimicrobial agents (except chloramphenicol) was significantly lower than that of Enterococcus faecium. Vancomycin resistant Enterococcus (VRE) was found to be Van A and Van B resistance according to phenotype, but not to linazolamide resistant Enterococcus. The sensitivity rate of 尾 hemolytic streptococcus to penicillin was 90.8%. The positive rates of Escherichia coli, Klebsiella (Klebsiella pneumoniae and Klebsiella acidogenic) and Proteus mirabilis were 54.2% and 28.9%, respectively. Enterobacteriaceae bacteria are still highly sensitive to carbapenes, and the total resistance rate is less than 3.3%. The detection rate of extensively resistant Klebsiella pneumoniae was 1.3%. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 17.5% and 11.8%, respectively, and 5.9% to amikacin. The resistance rates of Acinetobacter baumannii to the above two carbapenems were 69.0% and 67.4%, respectively. The resistance rates to cefoperazone-sulbactam and minocycline were 47.8% and 28.7%, respectively. The detection rates of Acinetobacter baumannii and Pseudomonas aeruginosa were 32.3% and 1.8%, respectively. The detection rate of 尾-lactamases in Haemophilus influenzae was 33. 7%. The resistance rate of Streptococcus pneumoniae to erythromycin and clindamycin was 933%. Conclusion the resistance rate of bacteria to antimicrobial agents is increasing, especially the carbapenem resistant Enterobacteriaceae, which should take effective measures to control nosocomial infection and strengthen the rational use of antimicrobial agents.
【作者单位】：中国医学科学院北京协和医学院北京协和医院检验科;
【分类号】：R446.5

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