协和医学杂志

2015, v.6(03) 179-185

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北京协和医院外科住院患者细菌耐药性监测
Surveillance of Antimicrobial Resistance among Clinical Isolates from Surgery Wards in Peking Union Medical College Hospital

张小江;杨启文;孙宏莉;王瑶;王贺;赵颖;朱任媛;窦红涛;张辉;徐英春;
ZHANG Xiao-jiang;YANG Qi-wen;SUN Hong-li;WANG Yao;WANG He;ZHAO Ying;ZHU Ren-yuan;DOU Hong-tao;ZHANG Hui;XU Ying-chun;Department of Clinical Laboratory Peking Union Medical College Hospital Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

目的了解北京协和医院外科住院患者临床分离细菌分布及对抗菌药物的耐药性。方法收集2012年1月1日至2013年12月31日北京协和医院外科住院患者临床分离的3084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2013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3084株非重复细菌中,10种最常见的细菌依次为鲍曼不动杆菌(14.1%)、大肠埃希菌(12.4%)、铜绿假单胞菌(12.4%)、肺炎克雷伯菌(11.8%)、金黄色葡萄球菌(8.9%)、粪肠球菌(5.4%)、凝固酶阴性葡萄球菌(5.3%)、阴沟肠杆菌(3.7%)、嗜麦芽窄食单胞菌(3.6%)和屎肠球菌(3.2%),其中革兰阴性菌占71.6%(2208株),革兰阳性菌占28.4%(876株)。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42.7%(117/274)和77.3%(119/154)。MRSA和MRCNS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 coagulasenegative Staphylococcus,MSCNS)。MRSA中80.3%菌株对磺胺甲噁唑-甲氧苄啶敏感,MRCNS中95.0%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的耐药率明显低于屎肠球菌,但后者对氯霉素的耐药率较低,仅为4.3%。分别发现1株和5株万古霉素耐药的粪肠球菌和屎肠球菌。未发现对利奈唑胺耐药的肠球菌。产超广谱β-内酰胺酶(extended spectrumβ-lactamases,ESBLs)的大肠埃希菌、克雷伯菌属细菌(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56.7%(217/383)、23.8%(97/408)和22.8%(13/57)。产ESBLs菌株的耐药率明显高于非产ESBLs菌株。肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感,总耐药率1.6%~3.3%。泛耐药肺炎克雷伯菌的检出率为0.8%(3/363)。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为19.5%和15.0%,对阿米卡星的耐药率最低(8.6%);鲍曼不动杆菌对上述两种抗菌药物的耐药率分别为74.1%和74.0%,对米诺环素和头孢哌酮-舒巴坦的耐药率最低(28.9%和51.5%)。泛耐药鲍曼不动杆菌和铜绿假单胞菌的检出率分别为44.3%(193/436)和0.8%(3/381)。结论定期进行耐药性监测有助于了解细菌耐药性变迁,为临床经验用药提供依据。
Objective To investigate the distribution and antimicrobial resistance of clinical isolates fromsurgery wards in Peking Union Medical College Hospital( PUMCH). Methods A total of 3084 non-duplicate clinical isolates were collected from PUMCH surgery wards during the period from January 1,2012 to December 31,2013. Disc diffusion test( Kirby-Bauer method) and automated systems were employed to detect the antimicrobial resistance of these isolates. The data were analyzed by WHONET 5. 6 software according to Clinical and Laboratory Standards Institute 2013 breakpoints. Results Of the 3084 clinical isolates,the 10 most common bacteria isolated were: A. baumannii( 14. 1%),E. coli( 12. 4%),P. aeruginosa( 12. 4%),K. pneumonia( 11. 8%),S. aureus( 8. 9%),E. faecalis( 5. 4%),coagulase-negative staphylococcus( 5. 3%),E. cloacae( 3. 7%),S. maltophilia( 3. 6%) and E. faecium( 3. 2%),in which gram-negative bacteria accounted for 71. 6%( 2208 isolates) and gram-positive accounted for 28. 4%( 876 isolates). In S. aureus and coagulase-negative staphylococcus,methicillin-resistant strains( MRSA and MRCNS) accounted for 42. 7%( 117 /274) and 77. 3%( 119 /154),respectively.The resistance rates of methicillin-resistance strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-susceptive strains including methicillin-susceptible Staphylococcus aureus( MSSA) and methicillin-susceptible coagulase-negative Staphylococcus( MSCNS). In addition,80. 3% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 95. 0% of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin,teicoplanin,or linezolid. The drug resistance rates of E. faecalis strains to most antimicrobials tested were much lower than those of E. faecium,except for the resistance rate to chloramphenicol,which was only 4. 3% in E. faecium. One strain of E. faecalis and 5 strains of E. faecium were found resistant to vancomycin. No linezolid-resistant strains were found in enterococcal isolates. Extended spectrum β-lactamases( ESBLs)-producing strains accounted for 56. 7%( 217 /383),23. 8%( 97 /408),and22. 8%( 13 /57) in E. coli,Klebsiella species( K. pneumoniae and K. oxytoca),and P. mirabilis,respectively.The drug resistance rates of ESBLs-producing strains were higher than the corresponding non-ESBLs-producing strains. Enterobacteriaceae strains were still highly susceptible to carbapenems,the overall resistance rates being1. 6%- 3. 3%. A few pan-resistant strains of K. pneumoniae( 0. 8%,3 /363) were identified. The resistance rates of P. aeruginosa to imipenem and meropenem were 19. 5% and 15. 0%,respectively,while the resistance rate to amikacin was the lowest( 8. 6%). The resistance rates of A. baumannii to imipenem and meropenem were74. 1% and 74. 0%,respectively,compared with the lowest resistance rates to cefoperazone-sulbactam( 51. 5%)and minocycline( 28. 9%). The prevalence of pan-resistant strains in A. baumannii and P. aeruginosa were 44. 3%( 193/436) and 0. 8%( 3/381),respectively. Conclusion Regular surveillance of bacterial resistance could provide practical guidance of rational selection of antimicrobial agents for clinicians.

关键词(KeyWords): 细菌耐药性监测;抗菌药;泛耐药菌;药敏试验
bacterial resistance surveillances;antimicrobial agents;pan-resistant bacterial;antimicrobial susceptibility testing

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作者(Author): 张小江;杨启文;孙宏莉;王瑶;王贺;赵颖;朱任媛;窦红涛;张辉;徐英春;
ZHANG Xiao-jiang;YANG Qi-wen;SUN Hong-li;WANG Yao;WANG He;ZHAO Ying;ZHU Ren-yuan;DOU Hong-tao;ZHANG Hui;XU Ying-chun;Department of Clinical Laboratory Peking Union Medical College Hospital Chinese Academy of Medical Sciences &Peking Union Medical College;

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