發(fā)布時(shí)間：2018-07-16 17:52

【摘要】：目的了解北京協(xié)和醫(yī)院2014年臨床分離細(xì)菌對(duì)抗菌藥物的耐藥性。方法共收集8 295株非重復(fù)分離菌,采用紙片擴(kuò)散法或自動(dòng)化儀器法進(jìn)行藥敏試驗(yàn),按CLSI 2014年版標(biāo)準(zhǔn)判讀藥敏結(jié)果,采用WHONET 5.6軟件進(jìn)行數(shù)據(jù)分析。結(jié)果 8 295株細(xì)菌中,革蘭陰性菌占67.4%,革蘭陽(yáng)性菌占32.6%。10種最常見(jiàn)的細(xì)菌分別為:大腸埃希菌(18.1%),銅綠假單胞菌(10.8%),肺炎克雷伯菌(10.2%),金黃色葡萄球菌(金葡菌)(9.8%),鮑曼不動(dòng)桿菌(9.2%),糞腸球菌(6.3%),屎腸球菌(4.1%),凝固酶陰性葡萄球菌(4.1%),陰溝腸桿菌(3.1%)和嗜麥芽窄食單胞菌(2.9%)。耐甲氧西林金葡菌(MRSA)和凝固酶陰性葡萄球菌(MRCNS)的檢出率分別為28.4%和66.5%。耐甲氧西林葡萄球菌對(duì)β內(nèi)酰胺類和其他抗菌藥物的耐藥率明顯高于甲氧西林敏感葡萄球菌。仍有81.3%MRSA對(duì)甲氧芐啶-磺胺甲VA敏感。MRCNS中有81.1%菌株對(duì)利福平敏感。未發(fā)現(xiàn)對(duì)萬(wàn)古霉素、替考拉寧和利奈唑胺耐藥的葡萄球菌。糞腸球菌對(duì)大多數(shù)抗菌藥物(除外氯霉素)的耐藥率明顯低于屎腸球菌。發(fā)現(xiàn)少數(shù)萬(wàn)古霉素耐藥腸球菌(VRE),根據(jù)表型推測(cè)為Van A和Van B型耐藥,未發(fā)現(xiàn)對(duì)利奈唑胺耐藥的腸球菌。β溶血鏈球菌對(duì)青霉素的敏感率為90.8%。產(chǎn)ESBL的大腸埃希菌、克雷伯菌屬(肺炎克雷伯菌和產(chǎn)酸克雷伯菌)和奇異變形桿菌的檢出率分別為54.2%、31.0%和28.9%。腸桿菌科細(xì)菌對(duì)碳青霉烯類仍高度敏感,總耐藥率≤3.3%。廣泛耐藥肺炎克雷伯菌的檢出率為1.3%。銅綠假單胞菌對(duì)亞胺培南和美羅培南的耐藥率分別為17.5%和11.8%,對(duì)阿米卡星的耐藥率5.9%。鮑曼不動(dòng)桿菌對(duì)上述2種碳青霉烯類抗生素的耐藥率分別為69.0%和67.4%,對(duì)頭孢哌酮-舒巴坦和米諾環(huán)素的耐藥率低,分別為47.8%和28.7%。廣泛耐藥鮑曼不動(dòng)桿菌和銅綠假單胞菌的檢出率分別是32.3%和1.8%。流感嗜血桿菌中β內(nèi)酰胺酶的檢出率為33.7%。肺炎鏈球菌對(duì)紅霉素和克林霉素的耐藥率93%。結(jié)論細(xì)菌對(duì)抗菌藥物的耐藥率呈增長(zhǎng)趨勢(shì),特別是碳青霉烯類耐藥腸桿菌科細(xì)菌,應(yīng)采取有效的醫(yī)院感染控制措施和加強(qiáng)抗菌藥物的合理使用。
[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.
【作者單位】： 中國(guó)醫(yī)學(xué)科學(xué)院 北京協(xié)和醫(yī)學(xué)院 北京協(xié)和醫(yī)院檢驗(yàn)科;
【分類號(hào)】：R446.5

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