2015-2017年广东某医院细菌耐药性监测结果分析
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摘要
目的了解广州医科大学附属第一医院2015-2017年临床分离菌对抗菌药物的耐药性。方法采用纸片扩散法或自动化仪器法进行抗菌药物敏感性试验,按照CLSI 2017年标准判读结果。结果收集2015年1月-2017年12月临床分离菌共17645株,其中革兰阳性菌3091株(17.5%),革兰阴性菌14554株(82.5%)。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)检出率分别为50.7%和77.9%,未发现万古霉素、替考拉宁和利奈唑胺耐药葡萄球菌株。肠球菌属中粪肠球菌对多数抗菌药物的耐药率显著低于屎肠球菌,检出万古霉素耐药屎肠球菌9株(0.8%)。检出肺炎链球菌非脑膜炎分离株227株,成人和儿童各占44.1%和55.9%,成人和儿童青霉素敏感菌株分别占88.0%和81.1%。大肠埃希菌是3年中检出率最高的细菌。大肠埃希菌和克雷伯菌属中产超广谱β内酰胺酶(ESBL)株分别占53.3%和28.5%。3年间检出碳青霉烯类耐药肠杆菌科细菌255株(3.7%),碳青霉烯类耐药铜绿假单胞菌665株(26.2%),碳青霉烯类耐药鲍曼不动杆菌900株(57.5%),每年检出率变化不大。3年间共检出泛耐药铜绿假单胞菌141株(5.6%),泛耐药鲍曼不动杆菌458株(29.3%),2015-2017年检出率呈下降趋势。结论该医院近3年细菌耐药情况趋于平稳,但仍应加强院感防控管理,继续做好细菌耐药监测工作。
Objective To investigate the susceptibility profile of clinical isolates in the First Affiliated Hospital of Guangzhou Medical University during 2015-2017. Methods Susceptibility test was carried out using Kirby-Bauer method or automated systems. Results were analyzed according to CLSI 2017 breakpoints. Results A total of 17 645 clinical isolates were isolated from January 2015 to December 2017, including 3 091(17.5%) gram positive and 14 554(82.5%) gram negative bacteria. Methicillinresistant S. aureus(MRSA) and coagulase-negative Staphylococcus(MRCNS) accounted for 50.7% and 77.9%, respectively. No staphylococcal isolates were found resistant to vancomycin, teicoplanin or linezolid. E. faecalis strains showed much lower resistance rate to most drugs tested than E. faecium. Nine(0.8%) E. faecalis isolates were found resistant to vancomycin. A total of 227 strains of the non-meningitis S. pneumoniae were tested, 44.1% of which were isolated from adults and 55.9% from children. Most of the S. pneumoniae isolated from adults and children were susceptible to penicillin(88.0% and 81.1%, respectively). E. coli showed the highest proportion in three years. ESBLs were produced in 53.3% of E. coli and 28.5% of Klebsiella spp. A total of 255 strains of carbapenem-resistant Enterobacteriaceae(3.7%), 665 strains of carbapenem-resistant Pseudomonas aeruginosa(26.2%) and 900 strains of carbapenem-resistant Acinetobacter baumannii(57.5%) were identified. The annual change of prevalence was insignificant. A total of 141 strains of extensively-drug resistant Pseudomonas aeruginosa(5.6%) and 458 strains of extensively-drug resistant A. baumannii(29.3%) were identified, showing decreasing prevalence from 2015 to 2017. Conclusions The bacterial resistance in this hospital is relatively stable in the past three years, but it is still necessary to strengthen hospital infection control and management, and maintain good practice in surveillance of bacterial resistance.
Objective To investigate the susceptibility profile of clinical isolates in the First Affiliated Hospital of Guangzhou Medical University during 2015-2017. Methods Susceptibility test was carried out using Kirby-Bauer method or automated systems. Results were analyzed according to CLSI 2017 breakpoints. Results A total of 17 645 clinical isolates were isolated from January 2015 to December 2017, including 3 091(17.5%) gram positive and 14 554(82.5%) gram negative bacteria. Methicillinresistant S. aureus(MRSA) and coagulase-negative Staphylococcus(MRCNS) accounted for 50.7% and 77.9%, respectively. No staphylococcal isolates were found resistant to vancomycin, teicoplanin or linezolid. E. faecalis strains showed much lower resistance rate to most drugs tested than E. faecium. Nine(0.8%) E. faecalis isolates were found resistant to vancomycin. A total of 227 strains of the non-meningitis S. pneumoniae were tested, 44.1% of which were isolated from adults and 55.9% from children. Most of the S. pneumoniae isolated from adults and children were susceptible to penicillin(88.0% and 81.1%, respectively). E. coli showed the highest proportion in three years. ESBLs were produced in 53.3% of E. coli and 28.5% of Klebsiella spp. A total of 255 strains of carbapenem-resistant Enterobacteriaceae(3.7%), 665 strains of carbapenem-resistant Pseudomonas aeruginosa(26.2%) and 900 strains of carbapenem-resistant Acinetobacter baumannii(57.5%) were identified. The annual change of prevalence was insignificant. A total of 141 strains of extensively-drug resistant Pseudomonas aeruginosa(5.6%) and 458 strains of extensively-drug resistant A. baumannii(29.3%) were identified, showing decreasing prevalence from 2015 to 2017. Conclusions The bacterial resistance in this hospital is relatively stable in the past three years, but it is still necessary to strengthen hospital infection control and management, and maintain good practice in surveillance of bacterial resistance.
引文
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[7]麦颖,管婧,苏丹虹,等.2005-2014年广州医科大学附属第一医院细菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):179-188.
[8] OBOLSKI U, ALON D, HAD ANY L, et al. Resistance profiles of coagulase-negative staphylococci contaminating blood cultures predict pathogen resistance and patient mortality[J]. J Antimicrob Chemother, 2014, 69(9):2541-2546.
[9] CATTOIR V, LECLERCQ R. Twenty-five years of shared life with vancomycin-resistant enterococci:is it time to divorce?[J].J Antimicrob Chemother, 2013, 68(4):731-742.
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[11]陈定强.携带β-内酰胺酶肠杆菌科细菌的耐药分子机制研究[D].南方医科大学,2017.
[12] IOVLEVA A, DOI Y. Carbapenem-Resistant Enterobacteriaceae[J]. Clin Lab Med, 2017, 37(2):303-315.
[13]王鹏鳃,陈定强,俞辉.多重耐药肺炎克雷伯菌中碳青霉烯酶的检测和分析[J].国际检验医学杂志,2016, 37(24):3423-3425.
[14]胡付品,朱德妹.医疗机构碳青霉烯类耐药肠杆菌科细菌感染防控指南简介[J].中国感染与化疗杂志,2018,18(3):331-335.
[2] Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing[S]. 2017,M100-S27.
[3] MAGIORAKOS A P, SRINIVASAN A, CAREY R B, et al.Multidrug-resistant, extensively drug-resistant and pandrugresistant bacteria:an international expert proposal for interim standard definitions for acquired resistance[J]. Clin Microbiol Infect, 2012, 18(3):268-281.
[4]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.
[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,朱德妹,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016, 16(6):685-694.
[7]麦颖,管婧,苏丹虹,等.2005-2014年广州医科大学附属第一医院细菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):179-188.
[8] OBOLSKI U, ALON D, HAD ANY L, et al. Resistance profiles of coagulase-negative staphylococci contaminating blood cultures predict pathogen resistance and patient mortality[J]. J Antimicrob Chemother, 2014, 69(9):2541-2546.
[9] CATTOIR V, LECLERCQ R. Twenty-five years of shared life with vancomycin-resistant enterococci:is it time to divorce?[J].J Antimicrob Chemother, 2013, 68(4):731-742.
[10] POULOU A, GRIVAKOU E, VRIONI G, et al. Modified CLSI extended-spectrumβ-lactamase(ESBL)confirmatory test for phenotypic detection of ESBLs among Enterobacteriaceae producing variousβ-lactamases[J]. J Clin Microbiol, 2014, 52(5):1483-1489.
[11]陈定强.携带β-内酰胺酶肠杆菌科细菌的耐药分子机制研究[D].南方医科大学,2017.
[12] IOVLEVA A, DOI Y. Carbapenem-Resistant Enterobacteriaceae[J]. Clin Lab Med, 2017, 37(2):303-315.
[13]王鹏鳃,陈定强,俞辉.多重耐药肺炎克雷伯菌中碳青霉烯酶的检测和分析[J].国际检验医学杂志,2016, 37(24):3423-3425.
[14]胡付品,朱德妹.医疗机构碳青霉烯类耐药肠杆菌科细菌感染防控指南简介[J].中国感染与化疗杂志,2018,18(3):331-335.