摘要
目的分析2016-2018年上海市第五人民医院常见临床分离菌的分布及耐药情况,为临床合理选用抗菌药物提供依据。方法回顾性分析各类临床标本分离菌的分布及耐药性数据,依据CLSI 2018年标准判断结果,应用WHONET 5.6和SPSS 22.0进行统计分析。结果2016-2018年共检出7995株细菌,其中革兰阴性杆菌5737株,占71.8%,革兰阳性球菌2258株,占28.2%。未检出耐万古霉素和利奈唑胺的葡萄球菌,MRSA和MRCNS占各自菌种的33.2%~41.5%和67.7%~79.4%;MRSA对甲氧苄啶-磺胺甲[口恶]唑耐药率≤5.6%。耐万古霉素肠球菌的检出率为0.5%。青霉素不敏感的肺炎链球菌检出率为8.4%。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌中ESBL的检出率分别为54.4%、27.1%和44.7%。肠杆菌科细菌(克雷伯菌属除外)对碳青霉烯类、阿米卡星、哌拉西林-他唑巴坦和头孢哌酮-舒巴坦耐药率较低,均≤8.6%。克雷伯菌属、铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为25.5%和25.6%、19.5%和19.6%。鲍曼不动杆菌对大多数常用抗菌药物的耐药率接近或超过60%。流感嗜血杆菌β内酰胺酶的检出率儿童高于成人(48.4%对34.2%)。卡他莫拉菌β内酰胺酶检出率为98.5%。结论该院2016-2018年细菌耐药情况总体趋于平稳,但近年来细菌对碳青霉烯类抗菌药物耐药率呈上升趋势,应继续做好细菌耐药性监测工作,为临床合理使用抗菌药物提供可靠依据。
Objective The distribution and antibiotic resistance profile of common clinical isolates were analyzed in Shanghai Fifth People's Hospital from 2016 through 2018 to provide evidence for rational selection of antimicrobial agents.Methods The data were retrospectively analyzed for all the clinical bacterial isolates.The results of bacterial susceptibility testing were interpreted according to the Clinical and Laboratory Standards Association(CLSI)2018 breakpoints.WHONET 5.6 and SPSS 22.0 software package were used for statistical analysis.Results A total of 7995 strains of bacteria were isolated in the period from 2016 through 2018,of which gram-negative bacilli accounted for 71.8%and gram-positive cocci accounted for 28.2%.No staphylococcal strain was found resistant to vancomycin or linezolid.The prevalence of methicillin-resistant strains was 33.2%-41.5% in S.aureus(MRSA)and 67.7%-79.4% in coagulase-negative Staphylococcus(MRCNS).About 5.6% of MRSA strains or less were resistant to trimethoprim-sulfamethoxazole.The prevalence of vancomycin-resistant Enterococcus(VRE)was 0.5%.The prevalence of penicillinnonsusceptible S.pneumoniae(PNSP)was 8.4%.The prevalence of ESBL were 54.4%,27.1%,and 44.7% in E.coli,K.pneumoniae,and P.mirabilis,respectively.Enterobacteriaceae(except Klebsiella spp.)isolates showed low resistance to carbapenems,amikacin,piperacillin-tazobactam,and cefoperazone-sulbactam(8.6%or lower resistant).The resistance rates of Klebsiella spp.and Pseudomonas aeruginosa to imipenem and meropenem were 25.5% and 25.6%,19.5% and 19.6%,respectively.The percentage of the A.baumannii resistant to the commonly used antibiotics was close to or higher than 60%.The prevalence ofβ-lactamase in H.influenzae was higher in children than in adults(48.4%versus 34.2%).The prevalence ofβ-lactamase was 98.5% in the M.catarrhalis isolates.Conclusions The prevalence of antibiotic-resistant bacterial isolates tends to be stable in this hospital from 2016 through 2018.However,carbapenem resistance appears to be increasing in recent years.Ongoing bacterial resistance surveillance should be a priority for rational use of antibacterial agents.
作者
张慧
沈芳
周聪
徐茂锁
刘亚隽
ZHANG Hui;SHEN Fang;ZHOU Cong;XU Maosuo;LIU Yajun(Department of Laboratory Medicine,Shanghai Fifth People's Hospital,Shanghai 200240,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2020年第2期187-194,共8页
Chinese Journal of Infection and Chemotherapy
基金
上海市第五人民医院院医学重点专科建设项目(2017WYZDZK15)。
关键词
临床分离菌
碳青霉烯类耐药
细菌耐药性监测
clinical isolates
carbapenem resistance
bacterial resistance surveillance
