本文選題：病原菌 + 抗菌藥物��； 參考：《中國(guó)感染與化療雜志》2017年06期

【摘要】：目的了解2015-2016年河北醫(yī)科大學(xué)第二醫(yī)院臨床分離病原菌耐藥情況。方法共收集16 292株非重復(fù)臨床分離菌,采用VITEK 2-Compact進(jìn)行細(xì)菌鑒定,采用自動(dòng)化儀器法結(jié)合紙片擴(kuò)散法進(jìn)行藥敏試驗(yàn),使用WHONET 5.6軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析。結(jié)果 2015、2016年分別收集臨床分離菌7 961株、8 331株,革蘭陰性菌分別占62.0%、66.9%。2年分離前5位的細(xì)菌是肺炎克雷伯菌、大腸埃希菌、鮑曼不動(dòng)桿菌、銅綠假單胞菌和金黃色葡萄球菌,2016年肺炎克雷伯菌分離率上升至第1位(16.1%),血標(biāo)本凝固酶陰性葡萄球菌分離率由2015年42.6%降至30.0%,葡萄球菌中未發(fā)現(xiàn)萬(wàn)古霉素耐藥株。2年耐甲氧西林金黃色葡萄球菌(MRSA)檢出率分別為56.2%、51.3%,耐甲氧西林凝固酶陰性葡萄球菌(MRCNS)為79.3%、63.1%。911株腸球菌屬細(xì)菌中糞腸球菌和屎腸球菌分別占25.2%和73.2%。2年屎腸球菌對(duì)萬(wàn)古霉素耐藥率分別為3.1%、2.9%,2016年肺炎克雷伯菌、大腸埃希菌、陰溝腸桿菌對(duì)碳青霉烯類(lèi)耐藥率持續(xù)上升,肺炎克雷伯菌對(duì)除慶大霉素、阿米卡星外所有選擇抗菌藥物耐藥率均呈現(xiàn)上升趨勢(shì),對(duì)亞胺培南、美羅培南耐藥率分別由2015年19.3%、18.5%上升至2016年24.2%、23.1%。2年間鮑曼不動(dòng)桿菌對(duì)常規(guī)選擇抗菌藥物依然維持較高的耐藥性,除多黏菌素B、替加環(huán)素、頭孢哌酮-舒巴坦、米諾環(huán)素外,對(duì)其他受試抗菌藥物耐藥率均高于50%。銅綠假單胞菌對(duì)阿米卡星、頭孢哌酮-舒巴坦,哌拉西林-他唑巴坦、頭孢他啶、頭孢吡肟耐藥率相對(duì)較低,分別為11.7%、15.5%、18.7%、20.1%、21.9%。2年間銅綠假單胞菌除對(duì)氨曲南耐藥率由2015年27.0%上升到2016年34.7%外,對(duì)其他抗菌藥物耐藥率均出現(xiàn)了下降趨勢(shì)。結(jié)論細(xì)菌對(duì)抗菌藥物的耐藥性在不斷變化,需采取有效的醫(yī)院感染防控措施,進(jìn)一步規(guī)范控制抗菌藥物使用。
[Abstract]:Objective to investigate the drug resistance of pathogenic bacteria isolated from the second Hospital of Hebei Medical University from 2015 to 2016. Methods A total of 16 292 strains of non-repeated clinical isolates were collected and identified by VITEK 2-Compact. The drug sensitivity test was performed by automatic instrument method combined with disk diffusion method, and the data were statistically analyzed by WHONET 5.6 software. Results among the 7 961 strains of clinical isolates collected in 2015 and 2016, 8 331 were Gram-negative bacteria, and the top 5 bacteria isolated in 66.9.2 years were Klebsiella pneumoniae, Escherichia coli and Acinetobacter baumannii, respectively, and the results showed that the most important bacteria were Klebsiella pneumoniae, Escherichia coli and Acinetobacter baumannii. Pseudomonas aeruginosa and Staphylococcus aureus, the isolation rate of Klebsiella pneumoniae increased to 16.1% in 2016, the isolation rate of coagulase-negative staphylococci in blood samples decreased from 42.6% in 2015 to 30.0%, and vancomycin resistant strain .2 was not found in Staphylococcus. The annual MRSAs of methicillin-resistant Staphylococcus aureus were 56.2% and 51.3%, respectively. The MRCNS of methicillin-resistant coagulase negative staphylococci were 79.3% and 63.1%, respectively. Among the 911 strains of Enterococcus, Enterococcus faecium and Enterococcus faecium accounted for 25.2% and 73.2.2% of Enterococcus faecium and Enterococcus faecium respectively. The drug resistance rates were 3.1% and 2.9%, respectively. In 2016, Klebsiella pneumoniae, The resistance rate of Escherichia coli to carbapenem and Klebsiella pneumoniae to all the antimicrobial agents except gentamicin and amikacin showed an increasing trend, and to imipenem, the resistance rate of Escherichia coli to carbapenem was increasing, and the resistance rate of Klebsiella pneumoniae to all antimicrobial agents except gentamicin and amikacin showed an increasing trend. The resistance rate of meropenem increased from 19.3g / 18.5% in 2015 to 24.2% in 2016, respectively. During the period of 23.1.2 years, Acinetobacter baumannii remained high resistance to conventional antimicrobial agents, except polymyxin B, tegacyclin, cefoperazone-sulbactam, minocycline. The rate of resistance to other antimicrobial agents was higher than that of 50%. The resistance rates of Pseudomonas aeruginosa to amikacin, cefoperazone-sulbactam, piperacillin-tazobactam, ceftazidime and cefepime were relatively low. The resistance rate of Pseudomonas aeruginosa to aztreonam increased from 27.0% in 2015 to 34.7% in 2016. Conclusion the antimicrobial resistance of bacteria is constantly changing, it is necessary to take effective measures to prevent and control nosocomial infection and to regulate the use of antimicrobial agents.
【作者單位】： 河北醫(yī)科大學(xué)第二醫(yī)院檢驗(yàn)科;河北醫(yī)科大學(xué);
【基金】：河北省科技廳指導(dǎo)性計(jì)劃(152777238)
【分類(lèi)號(hào)】：R446.5

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