2018-2020年凉山彝族地区某医院细菌耐药性监测分析

目的 了解凉山彝族地区细菌的耐药性,为临床合理使用抗菌药物提供依据。方法 收集凉山彝族自治州第一人民医院2018年1月1日-2020年12月31日临床分离的病原菌,采用全自动微生物鉴定及药敏系统对其进行鉴定及药敏试验,所有实验数据用WHONET5.6软件进行分析。结果 该院2018-2020年共分离出病原菌8 479株,其中革兰氏阴性菌5 509株,占64.97%,革兰氏阳性菌2 970株,占35.03%。分离出革兰氏阳性菌以金黄色葡萄球菌为主(974株),其对呋喃妥因、利奈唑胺、万古霉素、达托霉素的敏感度较高,但对青霉素、氨苄西林耐药性较高,同时检出耐甲氧西林金黄色葡萄球菌(MRSA)336株。检出革兰氏阴性菌以大肠埃希菌为主(1 894株),其对头孢唑林、头孢吡肟、头孢曲松、头孢噻肟、头孢他啶等抗生素的耐药性均大于60%,对替加环素敏感,耐药性仅为0.16%,对亚胺培南、美罗培南、厄他培南均有不同程度耐药。检出产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌共1 071株(57.92%),检出产ESBLs的肺炎克雷伯菌272株(32.27%)。结论 相比2015-2017年该院耐药菌监测数据,该院2018-2020年临床检出耐药菌有所变化,但耐药问题仍然严峻,应进一步合理使用抗菌药物、加强细菌耐药监测、严格实行隔离消毒等措施。

Monitoring of bacterial drug resistance in a hospital in the Liangshan Yi Area, 2018-2020

Objective To understand the drug resistance of bacteria in the Liangshan Yi Area, and to provide a basis for rational use of antibiotics in clinical practice. Methods We collected clinically isolated pathogens in the First People's Hospital of Liangshan Yi Autonomous Prefecture from January 1, 2018 to December 31, 2020. Automatic microorganism identification and drug sensitivity determination system was used to identify the pathogens and perform drug sensitivity test. All the experimental data were analyzed by WHONET 5.6 software. Results A total of 8,479 strains of pathogenic bacteria were isolated from the hospital in 2018-2020, of which gram-negative bacteria accounted for 64.97% (5,509/8,479) and gram-positive bacteria for 35.03% (2,970/8,479). Most of the gram-positive bacteria isolated were Staphylococcus aureus (974/2,970). They showed high sensitivity to nitrofurantoin, linezolid, vancomycin and daptomycin, but high resistance to penicillin and ampicillin. At the same time 336 strains of methicillin-resistant Staphylococcus aureus (MRSA) were detected. Most of the gram-negative bacteria detected were Escherichia coli (1,894/5,509). Their resistance to cefazolin, cefepime, ceftriaxone, cefotaxime and ceftazidime was all more than 60%, but they were sensitive to tigecycline, with the resistance being only 0.16%. They were resistant to imipenem, meropenem and ertapenem in different degrees. 1,071 strains of Escherichia coli producing extended spectrum beta-lactamases (ESBLs) (57.92%, 1,071/1,894) and 272 strains of Klebsiella pneumoniae (32.27%, 272/843) were detected. Conclusion There were some changes in the clinical drug-resistant bacteria detected in this hospital during2018-2020 compared with the surveillance data of drug-resistant bacteria during 2015-2017, but the drug resistance was still very serious. We should use antimicrobial agents rationally, strengthen the monitoring of bacterial drug resistance, and strictlyimplement isolation and disinfection measures.