【摘要】 目的了解北京市海淀医院2016年临床分离细菌对抗菌药物的耐药性。方法共收集2268株非重复分离菌株,自动化仪器法进行药敏试验,按CLSI 2016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 2268株细菌中,革兰阴性菌占75.6%,革兰阳性菌占24.4%。10种最常见的细菌分别为:大肠埃希菌(16.8%),肺炎克雷伯菌(13.4%),铜绿假单胞菌(11.6%),鲍曼不动杆菌(10.1%),凝固酶阴性葡萄球菌(8.0%),屎肠球菌(6.7%),阴沟肠杆菌(5.1%),嗜麦芽窄食单胞菌(3.8%),粪肠球菌(3.4%),金黄色葡萄球菌(金葡菌)(3.2%)。耐甲氧西林金葡菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)的检出率分别为34.2%和70.7%。耐甲氧西林葡萄球菌对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葡萄球菌。未发现对万古霉素、替加环素和利奈唑胺耐药的葡萄球菌。粪肠球菌(除四环素外)对大多数抗菌药物的耐药率明显低于屎肠球菌。发现少数万古霉素耐药肠球菌(VRE),未发现对利奈唑胺耐药的肠球菌。分离到的45株无乳链球菌对青霉素的敏感率为100%。肺炎链球菌对红霉素的耐药率为100%。克雷伯菌属对亚胺培南和美罗培南的耐药率为20.2%和19.6%,其它肠杆菌科细菌对碳青霉烯类仍高度敏感,总耐药率≤6.9%。多重耐药肺炎克雷伯菌的检出率为47.5%。铜绿假单胞菌对亚胺培南的耐药率为26.6%,对阿米卡星的耐药率1.5%。鲍曼不动杆菌亚胺培南的耐药率为42.3%,对阿米卡星的耐药率为2.4%。多重耐药鲍曼不动杆菌和铜绿假单胞菌的检出率分别是42.4%和28.9%。结论细菌对抗菌药物的耐药率呈下降趋势,特别是多重耐药的鲍曼不动杆菌下降明显,应持续采取有效的医院感染控制措施和加强抗菌药物的合理使用,进一步降低多重耐药菌的比例。更多还原

【Abstract】 Objective To investigate the antimicrobial resistance profile in the clinical bacterial strains isolated from Beijing Haidian Hospital during 2016. Methods A total of 2268 nonduplicate clinical isolates were collected. Disc diffusion test automated systems were employed to study the antimicrobial susceptibility. The data were analyzedby using WHONET 5. 6 software according to CLSI 2016 breakpoints. Results Of the 2268 isolates,75. 6% were gram-negative,and 24. 4% were gram-positive. The top 10 most frequently isolated bacteria were:E. coli(16. 8%),K. pneumoniae(13. 4%),P. aeruginosa(11. 6%),A. baumannii(10. 1%)coagulase-negative Staphylococcus(8. 0%),E. faecium(6. 7%),E. cloacae(5. 1%) S. maltophilia(3. 8%),E. faecalis(3. 4%),and S. aureus(3. 2%). Methicillin resistant strains in S. aureus(MRSA) and coagulase negative Staphylococcus(MRCNS) accounted for average of 34. 2% and 71. 5%,respectively. The resistance rates of MR strains to β-lactams and other antimicrobial agents were much higher than those MS strains. No staphylococcal strains were resistant to vancomycin,Tigecycline or linezolid. The resistance rate of E. faecalis strains to most of the drugs tested(except Tetracycline) was much lower than those of E. faecium. Several strains of E. faecium were found resistant to vancomycin,No linezolid resistant enterococcal strains were found. Data showed that 100% of S. agalactiae strains were susceptible to penicillin. All S. pneumoniae strains were resistant to Erythromycin. Enterobacteriaceae(except Klebsiella spp) isolates were still highly susceptible to carbapenems. Overall,no more than 6. 9% of these strains were resistant to carbapenems.Klebsiella spp has a high drug resistance rate 20. 2% and 19. 6% for both imipenem and meropenem.Multidrug-resistant strains of K. pneumoniae(41. 3%) were identified. The resistance rates of P. aeruginosa to imipenem were 26. 6%,respectively. P. aeruginosa isolates showed the lowest resistance rate(1. 5%) to amikacin. And 42. 3% of A. baumannii isolates were resistant to imipenem. A. baumannii isolates showed the lowest resistance rates to amikacin(2. 4%),respectively. The prevalence of multidrug-resistant strains was42. 4% in A. baumannii and 28. 9% in P. aeruginosa. Conclusion Bacterial resistance is decreasing in this hospital,especially there was a significant decrease in multidrug-resistant A. baumannii. It is necessary to take effective hospital infection control measures and use antibiotics rationally,Further reduce the proportion of multidrug-resistant bacteria.更多还原