2017年贵州省某综合型医院细菌耐药性监测及动态分析
|
摘要
目的分析2017年贵州省某综合型医院细菌耐药情况,并提出抗菌药物使用的合理性建议,以促进临床合理、安全的用药。方法采用纸片扩散法(KB法)对7697株临床分离菌株作药敏实验,以2017年CLSI标准判断药敏试验结果,采用WHONET 5.6软件,进行统计分析,结合我院细菌耐药结果对我院抗菌药物应用的合理性做出评价。结果 2017年我院共分离出病原菌7697株,其中革兰阴性菌4047株(52.58%),革兰阳性菌为2706株(35.16%)。MRSA的检出率为36.46%,未发现耐万古霉素的菌株;肠球菌属中,屎肠球菌和粪肠球菌均出现对万古霉素和替考拉宁耐药的菌株。肠杆菌科中大肠埃希菌对亚胺培南的耐药率为0.53%,肺炎克雷伯菌对亚胺培南的耐药率为15.94%;非发酵菌中铜绿假单胞菌对亚胺培南耐药率为22.99%,鲍曼不动杆菌对亚胺培南耐药率为67.31%。结论目前我院细菌耐药率不断攀升,长期进行细菌耐药监测有助于了解耐药情况,同时结合药物特点,为临床合理用药提供依据。
Objective To analyze the bacterial resistance of a comprehensive hospital in Guizhou Province in 2017, and to propose rationality recommendations for the use of antibiotics to promote rational and safe clinical use. Methods A paper-diffusion method(KB method) was used to test the drug-sensing strains of 7697 clinical isolates. The results of drug susceptibility test were judged by 2017 CLSI standard. The results were analyzed by WHONET 5.6 software, combined with the bacterial resistance results of our hospital. The rationality of the application of antibacterial drugs in the hospital was evaluated. Results In 2017, 7697 strains of pathogens were isolated from our hospital, including 4047(52.58%) Gramnegative bacteria and 2706(35.16%) Gram-positive bacteria. The detection rate of MRSA was 36.46%, and no vancomycin-resistant strain was found.In Enterococcus, Enterococcus faecium and Enterococcus faecalis showed strains resistant to vancomycin and teicoplanin. The resistance rate of Escherichia coli to imipenem in Enterobacteriaceae was 0.53%, and the resistance rate of Klebsiella pneumoniae to imipenem was 15.94%;Pseudomonas aeruginosa in non-fermentative bacteria The resistance rate of imipenem was 22.99%, and the resistance rate of Acinetobacter baumannii to imipenem was 67.31%. Conclusion At present, the bacterial resistance rate in our hospital is constantly rising. Long-term monitoring of bacterial resistance can help to understand the drug resistance, and at the same time, combined with the characteristics of the drug, provide a basis for clinical rational drug use.
Objective To analyze the bacterial resistance of a comprehensive hospital in Guizhou Province in 2017, and to propose rationality recommendations for the use of antibiotics to promote rational and safe clinical use. Methods A paper-diffusion method(KB method) was used to test the drug-sensing strains of 7697 clinical isolates. The results of drug susceptibility test were judged by 2017 CLSI standard. The results were analyzed by WHONET 5.6 software, combined with the bacterial resistance results of our hospital. The rationality of the application of antibacterial drugs in the hospital was evaluated. Results In 2017, 7697 strains of pathogens were isolated from our hospital, including 4047(52.58%) Gramnegative bacteria and 2706(35.16%) Gram-positive bacteria. The detection rate of MRSA was 36.46%, and no vancomycin-resistant strain was found.In Enterococcus, Enterococcus faecium and Enterococcus faecalis showed strains resistant to vancomycin and teicoplanin. The resistance rate of Escherichia coli to imipenem in Enterobacteriaceae was 0.53%, and the resistance rate of Klebsiella pneumoniae to imipenem was 15.94%;Pseudomonas aeruginosa in non-fermentative bacteria The resistance rate of imipenem was 22.99%, and the resistance rate of Acinetobacter baumannii to imipenem was 67.31%. Conclusion At present, the bacterial resistance rate in our hospital is constantly rising. Long-term monitoring of bacterial resistance can help to understand the drug resistance, and at the same time, combined with the characteristics of the drug, provide a basis for clinical rational drug use.
引文
[1]肖永红,沈萍,魏泽庆,等.Mohnarin 2011年度全国细菌耐药监测[J].中华医院感染学杂志,2012,22(22):4946-4952.
[2]李晓雨,马明葱.广东省2016年细菌耐药性监测及动态分析[J].中国抗生素杂志,2018,43(10):1263-1270.
[3]刘雪君,董芳.2017年福州市第二医院病原菌的分布及耐药性分析[J].现代药物与临床,2018,33(9):2435-2440.
[4]Clinical and Laboratory Standards Institute(CLSI).Performance Standards For Antimicrobial Susceptibilitytesting; 26th Informational Supplement[S].Clinical and Laboratory Standards Institute,2017,M100-S24.
[5]胡方芳,张华,季萍,等.中国西部地区2016-2017年下呼吸道标本分离细菌的分布及耐药性[J].中国抗生素杂志,2018,43(9):1089-1094.
[6]Nordmann P,Poirel I.Emerging carbapenemascs in Gramnegative aerobes[J].CBn Microbiol Infect,2002,8(12):321-331.
[7]胡付品,郭燕,朱德妹,等.2016中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[8]陈绍淳,张娟.产碳青霉烯酶的肺炎克雷伯菌耐药机制及流行病学研究进展[J].国际检验医学杂志,2016,37(23):3328-3330.
[9]罗洪英,余水泉.耐碳青霉烯类抗菌药物的耐药性及其相关影响因素[J].检验医学与临床,2018,15(4):492-495.
[10]Daikos GL,Tsaousi S,Tzouvelekis LS,et al.CarbapenemaseProducing klebsiella pneumoniae bloodstream infections:lowering mortality by antibiotic combination schemes and the role of carbapenems[J].Antimicrob Agents Chemother,2014,58(4):2322-2328.
[11]国家卫生计生委合理用药专家委员会全国细菌耐药监测网.2014年全国细菌耐药监测报告[J].中国执业药师,2016,13(2):3-8.
[12]中华医学会呼吸病学分会感染学组.铜绿假单胞菌下呼吸道感染诊治专家共识[J].中华结核和呼吸杂志,2014,37(1):9-15.
[13]付维婵,邱红,赵德军,等.2012年我院住院患者金黄色葡萄球菌感染调查及耐药性分析[J].中国药业,2014,23(5):47-48.
[14]纪冰,王凤霞,赵红梅,等.社区和医院获得性耐甲氧西林金黄色葡萄球菌MLST联合SCCmec基因分型及耐药性比较[J].中国抗生素杂志,2017,42(1):52-55.
[15]耐甲氧西林金黄色葡萄球菌感染防治专家委员会.耐甲氧西林金黄色葡萄球菌感染防治专家共识2011年更新版[J].中华实验和临床感染病杂志:电子版,2011,5(3):372-384.
[2]李晓雨,马明葱.广东省2016年细菌耐药性监测及动态分析[J].中国抗生素杂志,2018,43(10):1263-1270.
[3]刘雪君,董芳.2017年福州市第二医院病原菌的分布及耐药性分析[J].现代药物与临床,2018,33(9):2435-2440.
[4]Clinical and Laboratory Standards Institute(CLSI).Performance Standards For Antimicrobial Susceptibilitytesting; 26th Informational Supplement[S].Clinical and Laboratory Standards Institute,2017,M100-S24.
[5]胡方芳,张华,季萍,等.中国西部地区2016-2017年下呼吸道标本分离细菌的分布及耐药性[J].中国抗生素杂志,2018,43(9):1089-1094.
[6]Nordmann P,Poirel I.Emerging carbapenemascs in Gramnegative aerobes[J].CBn Microbiol Infect,2002,8(12):321-331.
[7]胡付品,郭燕,朱德妹,等.2016中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[8]陈绍淳,张娟.产碳青霉烯酶的肺炎克雷伯菌耐药机制及流行病学研究进展[J].国际检验医学杂志,2016,37(23):3328-3330.
[9]罗洪英,余水泉.耐碳青霉烯类抗菌药物的耐药性及其相关影响因素[J].检验医学与临床,2018,15(4):492-495.
[10]Daikos GL,Tsaousi S,Tzouvelekis LS,et al.CarbapenemaseProducing klebsiella pneumoniae bloodstream infections:lowering mortality by antibiotic combination schemes and the role of carbapenems[J].Antimicrob Agents Chemother,2014,58(4):2322-2328.
[11]国家卫生计生委合理用药专家委员会全国细菌耐药监测网.2014年全国细菌耐药监测报告[J].中国执业药师,2016,13(2):3-8.
[12]中华医学会呼吸病学分会感染学组.铜绿假单胞菌下呼吸道感染诊治专家共识[J].中华结核和呼吸杂志,2014,37(1):9-15.
[13]付维婵,邱红,赵德军,等.2012年我院住院患者金黄色葡萄球菌感染调查及耐药性分析[J].中国药业,2014,23(5):47-48.
[14]纪冰,王凤霞,赵红梅,等.社区和医院获得性耐甲氧西林金黄色葡萄球菌MLST联合SCCmec基因分型及耐药性比较[J].中国抗生素杂志,2017,42(1):52-55.
[15]耐甲氧西林金黄色葡萄球菌感染防治专家委员会.耐甲氧西林金黄色葡萄球菌感染防治专家共识2011年更新版[J].中华实验和临床感染病杂志:电子版,2011,5(3):372-384.