2016-2017年医院病原菌的分布及耐药性分析
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摘要
目的了解临沂市人民医院2016-2017年病原菌的分布及耐药情况,为临床合理使用抗菌药物提供参考依据。方法根据CLSI 2016年版、2017年版标准,用WHONET 5.6软件,回顾性分析了2016-2017年该院临床分离菌株的分布及耐药性。结果 2年间全院共分离出病原菌19 940株,其中革兰阴性杆菌占64.7%,主要以大肠埃希菌(17.3%)、肺炎克雷伯菌(13.2%)、铜绿假单胞菌(9.2%)、鲍曼不动杆菌(7.3%)为主;革兰阳性球菌占30.8%,主要以金黄色葡萄球菌(8.4%)、肺炎链球菌(6.4%)和表皮葡萄球菌(4.1%)为主。大肠埃希菌、肺炎克雷伯菌对替加环素、多粘菌素、碳青霉烯类、酶抑制剂复合剂的耐药率多低于5%;铜绿假单胞菌、鲍曼不动杆菌未发现对多粘菌素B耐药的菌株,对替加环素敏感,对其他抗菌药物大都耐药。金黄色葡萄球菌和表皮葡萄球菌多产β-内酰胺酶,对β-内酰胺类抗菌药物、红霉素、克林霉素耐药严重,目前未检出对万古霉素、利奈唑胺耐药的菌株;肺炎链球菌对红霉素、克林霉素、复方新诺明耐药,而对其他抗菌药物大都敏感。结论近2年该院病原菌感染以革兰阴性菌为主,其中大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌的检出率增长迅速,鲍曼不动杆菌的耐药性极为严重。多重耐药性细菌仍然是临床面临的重要问题,医院应加强对细菌的监测,以减少耐药菌株的产生,控制医院感染。
Objective To understand the distribution and drug resistance of pathogens in Linyi People's Hospital from 2016 to 2017,and provide a reference for clinical rational use of antibiotics.Methods Based on the CLSI 2016 and 2017 edition standards,the distribution and drug resistance of the clinical isolates from 2016 to 2017 were retrospectively analyzed using WHONET 5.6 software.Results In the past two years,a total of 19 940 strains of pathogenic bacteria were isolated,of which Gram-negative bacilli accounted for 64.7%,mainly including Escherichia coli(17.3%),Klebsiella pneumoniae(13.2%),Pseudomonas aeruginosa(9.2%) and Acinetobacter baumannii(7.3%).Gram-positive cocci accounted for 30.8%,mainly staphylococcus aureus(8.4%),streptococcus pneumoniae(6.4%) and staphylococcus epidermidis(4.1%).Escherichia coli,Klebsiella pneumoniae resistance to tigecycline,polymyxin,carbapenems,enzyme inhibitor complexes were less than 5%;Pseudomonas aeruginosa,Bowman Acinetobacter has not found a strain resistant to polymyxin B,sensitive to tigecycline,and most resistant to other antibacterial drugs.Staphylococcus aureus and Staphylococcus epidermidis produced β-lactamase,which was highly resistant to β-lactam antibiotics,erythromycin and clindamycin.No resistance to vancomycin or linezolid has been detected.The strain of the drug;Streptococcus pneumoniae was resistant to erythromycin,clindamycin,and cotrimoxazole,and was mostly sensitive to other antibacterial drugs.Conclusion Gram-negative bacteria are the main pathogenic bacteria in our hospital in recent two years.The detection rate of Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa increased rapidly.Acinetobacter baumannii is highly resistant to antibiotics.Multidrug-resistant bacteria are still an important clinical problem.The hospitals should strengthen the monitoring of bacteria to reduce the production of drug-resistant bacteria and control nosocomial infection.
Objective To understand the distribution and drug resistance of pathogens in Linyi People's Hospital from 2016 to 2017,and provide a reference for clinical rational use of antibiotics.Methods Based on the CLSI 2016 and 2017 edition standards,the distribution and drug resistance of the clinical isolates from 2016 to 2017 were retrospectively analyzed using WHONET 5.6 software.Results In the past two years,a total of 19 940 strains of pathogenic bacteria were isolated,of which Gram-negative bacilli accounted for 64.7%,mainly including Escherichia coli(17.3%),Klebsiella pneumoniae(13.2%),Pseudomonas aeruginosa(9.2%) and Acinetobacter baumannii(7.3%).Gram-positive cocci accounted for 30.8%,mainly staphylococcus aureus(8.4%),streptococcus pneumoniae(6.4%) and staphylococcus epidermidis(4.1%).Escherichia coli,Klebsiella pneumoniae resistance to tigecycline,polymyxin,carbapenems,enzyme inhibitor complexes were less than 5%;Pseudomonas aeruginosa,Bowman Acinetobacter has not found a strain resistant to polymyxin B,sensitive to tigecycline,and most resistant to other antibacterial drugs.Staphylococcus aureus and Staphylococcus epidermidis produced β-lactamase,which was highly resistant to β-lactam antibiotics,erythromycin and clindamycin.No resistance to vancomycin or linezolid has been detected.The strain of the drug;Streptococcus pneumoniae was resistant to erythromycin,clindamycin,and cotrimoxazole,and was mostly sensitive to other antibacterial drugs.Conclusion Gram-negative bacteria are the main pathogenic bacteria in our hospital in recent two years.The detection rate of Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa increased rapidly.Acinetobacter baumannii is highly resistant to antibiotics.Multidrug-resistant bacteria are still an important clinical problem.The hospitals should strengthen the monitoring of bacteria to reduce the production of drug-resistant bacteria and control nosocomial infection.
引文
[1] 吴京宇,朱建喜.某医院2016年多重耐药菌的分布特点及其耐药性分析[J].抗感染药学,2017,14(6):1115-1117.
[2] 徐添天,谢瑞玉.2014-2016年安徽省滁州市儿童医院临床分离菌耐药性监测[J].中国感染与化疗杂志,2017,17(6):663-667.
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[5] 胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[6] 胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[7] 徐英春,肖永红,卓超,等.中国碳青霉烯类耐药肠杆菌科细菌的流行病学和防控策略[J].中国执业药师,2013,10(4):3-8.
[8] Kerbauy G,Vivan AC,Sim?es GC,et al.Effect of a metalloantibiotic produced by pseudomonas aeruginosa on klebsiella pneumoniae carbapenemase(KPC)-producing K.pneumoniae[J].Current Pharmaceutical Biotechnology,2016,17(4):389-397.
[9] 范会,王丽萍,邵春红,等.2012-2016年山东省立医院细菌耐药性监测与分析[J].药物流行病学杂志,2017,26(10):700-707.
[10] 赵吴静,徐进强,武中庸,等.苯唑西林敏感耐甲氧西林金黄色葡萄球菌研究进展[J].中国畜牧兽医,2017,44(8):2458-2464.
[2] 徐添天,谢瑞玉.2014-2016年安徽省滁州市儿童医院临床分离菌耐药性监测[J].中国感染与化疗杂志,2017,17(6):663-667.
[3] Clinical and Laboratory Standards Institute(CLSI).M100-S26 Performance standards for antimicrobial susceptibility testing[S].America:Clinical and Laboratory Standards Institute,2016.
[4] Clinical and Laboratory Standards Institute(CLSI).M100-S27 Performance standards for antimicrobial susceptibility testing[S].America:Clinical and Laboratory Standards Institute,2017.
[5] 胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[6] 胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[7] 徐英春,肖永红,卓超,等.中国碳青霉烯类耐药肠杆菌科细菌的流行病学和防控策略[J].中国执业药师,2013,10(4):3-8.
[8] Kerbauy G,Vivan AC,Sim?es GC,et al.Effect of a metalloantibiotic produced by pseudomonas aeruginosa on klebsiella pneumoniae carbapenemase(KPC)-producing K.pneumoniae[J].Current Pharmaceutical Biotechnology,2016,17(4):389-397.
[9] 范会,王丽萍,邵春红,等.2012-2016年山东省立医院细菌耐药性监测与分析[J].药物流行病学杂志,2017,26(10):700-707.
[10] 赵吴静,徐进强,武中庸,等.苯唑西林敏感耐甲氧西林金黄色葡萄球菌研究进展[J].中国畜牧兽医,2017,44(8):2458-2464.