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| 2012～2016年山东省立医院细菌耐药性监测与分析 |
| Surveillance of Antibiotic Resistance in Clinical Isolates from Shandong Provincial Hospital during 2012-2016 |
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| DOI： |
| 中文关键词: 细菌耐药性监测 抗菌药物 药敏试验 多重耐药菌 |
| 英文关键词:Antibiotic resistance surveillance Antimicrobial agent Bacterial susceptibility testing Multi drug resistant bacterium |
| 基金项目:国家自然科学基金项目（编号：81401696）；山东省重点研发计划项目（编号：2016GSF201078） |
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| 中文摘要: |
| 摘 要 目的：分析山东省立医院2012～2016年临床分离细菌的分布及对常用抗菌药物的耐药性变迁。方法：除葡萄球菌属采用VITEK 2 Compact 测定其药物敏感性外，其余菌株均采用纸片扩散法。参照CLSI 2016版折点判读结果，使用WHONET5.6软件统计分析。结果：2012～2016年共收集非重复临床分离菌21 568株，其中革兰阴性菌占69.58%，革兰阳性菌占30.42%。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类和阿米卡星抗菌药物敏感性最高，在90%以上；共检出碳青霉烯类抗菌药物耐药的肠杆菌科（CRE）393株。铜绿假单胞菌敏感率最高的药物是阿米卡星（87.8%）和哌拉西林/他唑巴坦（86.8%）；鲍曼不动杆菌除对头孢哌酮/舒巴坦（耐药率27.2%）和米诺环素（34.9%）敏感外，其余抗菌药物的耐药率均在40%以上。甲氧西林耐药金色葡萄球菌（MRSA）的平均检出率为30.8%。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。屎肠球菌对多数药物的耐药率高于粪肠球菌，5年间共检出9株万古霉素耐药的肠球菌（VRE）。肺炎链球菌对红霉素和克林霉素的耐药率均在96%以上，非脑膜炎菌株中检出青霉素耐药株（PRSP）14株，占1.30%，脑膜炎菌株中检出PRSP 5株，占35.71%。流感嗜血杆菌β内酰胺酶阳性率为56.00%。结论：该院5年监测数据显示，细菌的耐药性呈增高趋势，尤其是多重耐药菌的分离率亦升高明显，应重视细菌耐药性监测并应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。 |
| 英文摘要: |
| ABSTRACT Objective:To investigate the antibiotic resistance of clinical isolates in Shandong Provincial Hospital during 2012-2016.Methods:The antimicrobial susceptibility of staphylococcal strains was tested by WHONET 5.6 software according to CLSI 2016 breakpoints. Results:A total of 21 568 non duplicate clinical strains were collected during 2012 2016, of which gram negative rods and gram positive cocci accounted for 69.58% and 30.42%.The sensitive rate of E.coli and K.pneumoniae to carbapenems and amikacin was more than 90%. A total of 393 carbapenem resistant Enterobacteriaceae (CRE) were detected. P.aeruginosa was more sensitive to amikacin (87.8%) and piperacillin/tazobactam(86.8%) than other antibiotics tested. More than 40% of the A.baumannii strains were resistant to all the antibiotics tested except cefoperazone/shubatan (27.2%) and minocycline (34.9%). The prevalence of methicillin resistant S.sureus (MRSA) was 30.80%. No strains were found resistant to vancomycin, teicoplanin or linezolid in Staphylocoous spp.. The percentage of the E.faecium strains resistant to most antibiotics tested was higher than that of E.faecalis. In five years,there were 9 strains of vancomycin resistant enterococcus founded. The resistance rate of Streptococcus pneumoniae to erythromycin and clindamycin were both more than 96%. 14 Penicillin resistant strains (PRSP) were detected in non meningitis strains and 5 PRSP in meningitis strains, accounting for 1.30% and 35.71% respectively. The prevalence of β lactamase in H.influenzae was 56.00%. Conclusion:Bacterial resistance was on the rise. More attention should be paid to resistance surveillance and rational use of antibiotics. |
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