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目的了解2015年北京协和医院临床分离细菌对抗菌药物的耐药性。方法收集2015年1月1日至12月31日北京协和医院临床分离的5746株非重复细菌,采用纸片扩散法或自动化仪器法进行药敏试验,按美国临床实验室标准化协会2015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 5746株非重复细菌中,10种最常见细菌分别为:大肠埃希菌(19.4%)、铜绿假单胞菌(11.3%)、肺炎克雷伯菌(10.9%)、金黄色葡萄球菌(9.8%)、鲍曼不动杆菌(9.6%)、粪肠球菌(6.5%)、B群链球菌(5.1%)、屎肠球菌(4.6%)、凝固酶阴性葡萄球菌(2.7%)、阴沟肠杆菌(2.5%)。其中革兰阴性菌占67.5%,革兰阳性菌占32.5%。耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococcus,MRCNS)的检出率分别为22.9%和77.6%。MRSA和MRCNS菌株对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金黄色葡萄球菌(methicillin-susceptible Staphylococcus aureus,MSSA)和甲氧西林敏感凝固酶阴性葡萄球菌(methicillin-susceptible coagulase-negative Staphylococcus,MSCNS)菌株。仍有88.8%的MRSA对磺胺甲噁唑-甲氧苄啶敏感。MRCNS中有81.7%的菌株对利福平敏感。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(除氯霉素外)的耐药率要明显低于屎肠球菌。两者中均有少数万古霉素耐药株,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%。产超广谱β-内酰胺酶的大肠埃希菌、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52.3%(582/1112)、28.9%(200/692)和26.2%(27/103)。肠杆菌科细菌对碳青霉烯类仍高度敏感,总耐药率≤4.3%。泛耐药肺炎克雷伯菌的检出率为3.0%(19/630)。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为76.5%和74.8%,对头孢哌酮-舒巴坦和米诺环素的耐药率最低,分别为49.8%和21.8%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为16.6%和11.9%,对阿米卡星的耐药率最低(5.2%)。泛耐药鲍曼不动杆菌和铜绿假单胞菌的检出率分别是20.8%(115/553)和1.8%(12/650)。结论细菌耐药性仍对临床构成严重威胁,临床需合理规范应用抗菌药物,避免耐药菌株的广泛传播。
Objective To understand the clinical drug resistance of clinical isolates from Peking Union Medical College Hospital in 2015. Methods 5746 non-repetitive bacteria isolated from Peking Union Medical College Hospital from January 1, 2015 to December 31, 2015 were collected. Drug susceptibility testing was conducted by disk diffusion or automated instrumentation. According to the standard of American Society of Clinical Laboratory Standards 2015 version Susceptibility results, using WHONET 5.6 software for data analysis. Results Of the 5746 non-repetitive bacteria, the 10 most common bacteria were Escherichia coli (19.4%), Pseudomonas aeruginosa (11.3%), Klebsiella pneumoniae (10.9%), Staphylococcus aureus 9.8%), Acinetobacter baumannii (9.6%), Enterococcus faecalis (6.5%), Group B Streptococcus (5.1%), Enterococcus faecium (4.6%), Coagulase negative staphylococcus (2.7% Enterobacteriaceae (2.5%). Gram-negative bacteria accounted for 67.5%, Gram-positive bacteria accounted for 32.5%. The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) were 22.9% and 77.6%, respectively. The resistance rate of MRSA and MRCNS strains to β-lactams and other antibiotics was significantly higher than that of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-sensitive coagulase-negative Staphylococcus aureus (methicillin- susceptible coagulase-negative Staphylococcus, MSCNS) strain. 88.8% of MRSA is still sensitive to sulfamethoxazole-trimethoprim. 81.7% of strains in MRCNS were sensitive to rifampicin. No staphylococci resistant to vancomycin, teicoplanin and linezolid were found. Enterococcus faecalis most antibacterial drugs (except chloramphenicol) resistance rate was significantly lower than Enterococcus faecium. There was a minority of vancomycin resistant strains in both, and no enterococci resistant to linezolid was found. The sensitivity of β-hemolytic streptococcus to penicillin was 90.8%. The detection rates of extended-spectrum β-lactamase-producing Escherichia coli, Klebsiella (Klebsiella pneumoniae and Klebsiella oxytoca) and Proteus mirabilis were 52.3% (582/1112 ), 28.9% (200/692) and 26.2% (27/103). Enterobacteriaceae is still highly sensitive to carbapenems, with a total resistance rate of ≤ 4.3%. The detection rate of pan-drug resistant Klebsiella pneumoniae was 3.0% (19/630). Acinetobacter baumannii resistance rates to imipenem and meropenem were 76.5% and 74.8%, respectively. The resistance rate to cefoperazone-sulbactam and minocycline was the lowest (49.8% and 21.8%, respectively) . The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 16.6% and 11.9%, respectively, and the resistance rate to amikacin was the lowest (5.2%). The detection rates of pan-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa were 20.8% (115/553) and 1.8% (12/650), respectively. Conclusions Bacterial drug resistance still poses a serious threat to clinical practice. Clinical application of antimicrobial agents should be standardized and reasonable to avoid the widespread transmission of drug-resistant strains.