摘要
目的监测2020年1月1日—2023年12月31日赣州市人民医院临床分离菌的分布,并分析其对抗菌药物的耐药性。方法收集赣州市人民医院2020年—2023年临床分离菌株(非重复),采用自动化仪器法进行细菌鉴定和抗菌药物敏感性试验,按照当年美国临床和实验室标准化协会(CLSI)推荐的抗菌药物敏感性试验执行标准判断药敏。结果2020年—2023年该院共收集临床分离菌26766株,其中革兰阴性菌68.99%(18465株),革兰阳性菌27.71%(7418株),真菌3.30%(883株)。临床分离菌前五位依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌和铜绿假单胞菌。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为30.01%,未发现对万古霉素、替加环素和利奈唑胺耐药的金黄色葡萄球菌,其对左氧氟沙星的耐药率呈上升趋势(P<0.05)。未发现肠球菌对替加环素耐药,未发现耐万古霉素的粪肠球菌。2022年和2023年分别分离出2株和6株耐万古霉素的屎肠球菌。除了利奈唑胺和高浓度庆大霉素,屎肠球菌对其他抗菌药物的耐药率比粪肠球菌更高。粪肠球菌和屎肠球菌对高浓度庆大霉素的耐药率呈逐年上升趋势(P<0.05)。链球菌属中,2022年分离出4株青霉素G耐药株;2023年,分离出2株左氧氟沙星、1株莫西沙星和1株氧氟沙星耐药株。耐碳青霉烯类肠杆菌目细菌(CRE)检出率6.2%,产超广谱β-内酰胺酶(ESBL)大肠埃希菌检出率为38.9%。未发现对替加环素耐药的肠杆菌。大肠埃希菌对厄他培南、亚胺培南和阿米卡星的耐药较低,对头孢呋辛和头孢曲松的耐药率逐年呈下降趋势(P<0.05)。肺炎克雷伯菌对头孢哌酮/舒巴坦、厄他培南和亚胺培南的耐药率逐年呈上升趋势(P<0.05)。碳青霉烯类耐药鲍曼不动杆菌(CRAB)检出率为69.13%。未发现耐美罗培南和左氧氟沙星的流感嗜血杆菌。结论临床分离菌主要以革兰阴性菌为主,临床常见的分离菌耐药率总体呈增长趋势,尤其是耐碳青霉烯类革兰阴性杆菌耐药率上升明显,医院各部门应共同协作加强医院感染预防与控制,共同遏制微生物耐药。
Objective To investigate the antimicrobial resistance of clinical isolates in Ganzhou People’s Hospital from January 1,2020 to December 31,2023.Methods Clinical isolates from our hospital between 2020 and 2023 were collected.Using automated systems for bacterial identification and antimicrobial susceptibility testing.Results A total of 26766 non-duplicate isolates were collected from 2020 to 2023,including grampositive microorganisms(27.71%,7418/26766)and gram-negative bacteria(68.99%,18476/26766).Pseudomonas aeruginosa,Staphylococcus aureus,Acinetobacter baumannii,Klebsiella pneumoniae,and Escherichia coli were the top five clinical isolates,ranked from high to low.The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was 30.01%.No Staphylococcus aureus resistant to vancomycin,linezolid,or tigecycline was found.The resistance rate of Staphylococcus aureus to levofloxacin showed an increasing trend(P<0.05).No tigecycline-resistant Enterococcus faecalis and Enterococcus faecium were found.No vancomycin-resistant Enterococcus faecalis was found.In 2022 and 2023,2 and 6 strains of vancomycin-resistant Enterococcus faecalis were found respectively.Compared with Enterococcus faecalis,Enterococcus faecium has a higher resistance rate to common antimicrobial drugs(except for high concentrations of gentamicin and linezolid).The resistance rates of Enterococcus faecalis and Enterococcus faecium to high concentrations of gentamicin increased year by year(P<0.05).No ertapenem-resistant,linezolid-resistant,or vancomycin-resistant strains were found.In 2022,four penicillin G-resistant strains were found.In 2023,two levofloxacin-resistant strains were found.One moxifloxacin-resistant strain and one ofloxacin-resistant strain were found in 2023.The detection rate of carbapenem-resistant Enterobacteriaceae(CRE)was 6.2%.The detection rate of extended-spectrumβ-lactamase(ESBL)bacteria was 38.9%.No Enterobacteriaceae resistant to tigecycline were found.Escherichia coli was more sensitive to ertapenem,imipenem and amikacin.The resistance rates of Escherichia coli to cefuroxime and ceftriaxone showed a decreasing trend year by year(P<0.05).The resistance rate of Klebsiella pneumoniae to cefoperazone/sulbactam,ertapenem and imipenem is increasing year by year(P<0.05).The detection rate of carbapenem-resistant Acinetobacter baumannii(CRAB)was 69.13%.No Haemophilus influenzae resistant to meropenem and levofloxacin was found.Conclusions Gram-negative bacteria make up the majority of clinically isolated bacteria,and the resistance rate of frequently isolated bacteria is generally rising,particularly for carbapenem-resistant Gram-negative bacteria.All departments of the hospital should work together to strengthen hospital infection prevention and control and jointly curb microbial resistance.
作者
林小芳
丁明丽
胡涛
罗锋
邹淑慧
张丽琴
黄绍通
Lin Xiao-fang;Ding Ming-li;Hu Tao;Luo Feng;Zou Shu-hui;Zhang Li-qin;Huang Shao-tong(Ganzhou People’s Hospital,Ganzhou Jiangxi 341000)
基金
江西省卫生健康委科技计划项目(220234941)。
关键词
细菌耐药性监测
抗菌药物
药物敏感性试验
合理用药
病原菌
耐药性
bacterial resistance surveillance
antimicrobial agent
antimicrobial susceptibility testing
rational drug use
pathogenic bacteria
drug resistance
