2014～2016年崇左市细菌耐药监测分析
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摘要
目的了解崇左市病原菌分布及耐药情况,掌握该区域细菌耐药变迁形势,为抗菌药的合理应用提供依据。方法统计分析崇左市辖区的七家综合性医院2014～2016年临床分离菌构成及细菌耐药情况。共收集病原微生物标本172 367份,分离出细菌18 256株。采用纸片法或最小抑菌浓度(MIC)法测定抗菌药的敏感性,试验标准与判定标准按各年的美国临床和实验室标准协会(CLSI)标准,用WHONET5.6软件对数据进行统计分析。结果崇左地区3年临床分离病原菌中革兰阳性菌占24.3%,革兰阴性菌占75.7%。2014～2016年分离病原菌中排在首位的革兰阳性菌均为金黄色葡萄球菌,第二位的均为表皮葡萄球菌;分离病原菌中革兰阴性菌排在前五位的依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、阳沟杆菌。2014～2016年崇左市甲氧西林耐药的金黄色葡萄球菌(MRSA)检出率依次为:18.3%、24.9%、26.0%,万古霉素耐药粪肠球菌检出率依次为:2.8%、0.0%、0.0%,未检出万古霉素耐药的屎肠球菌。2014～2016年,青霉素耐药肺炎链球菌(PRSP)和红霉素耐药肺炎链球菌(ERSP)检出率分别为:67.6%、68.9%、68.2%和92.3%、96.5%、94.4%。对第三代头孢菌素、碳青霉烯类和喹诺酮类耐药的大肠埃希菌检出率分别为:51.1%、47.8%、45.2%;0.9%、0.7%、0.4%和42.2%、44.6%、40.9%。对第三代头孢菌素和碳青霉烯类耐药的肺炎克雷伯菌检出率分别为:31.0%、26.6%、23.6%和0.7%、2.0%、1.8%。对碳青霉烯类耐药的铜绿假单胞菌和鲍曼不动杆菌检出率分别为:6.5%、14.4%、11.9%和25.4%、42.3%、38.6%。结论崇左市细菌耐药性严重,2014～2016年MRSA检出率呈逐年上升趋势,PRSP检出率远高于广西和全国平均水平,碳青霉烯类抗菌药的耐药率升高较快,应加强抗菌药应用管理和细菌耐药监测。
Objective To understand the distribution and drug resistance of pathogenic bacteria in Chongzuo City, and to grasp the situation of bacterial resistance change in this region, and provide a basis for the rational application of antibacterial drugs. Methods Data of clinical isolation pathogenic bacteria composition and drug resistance in 7 general hospitals from 2014 to 2016 were analysed. A total of 172 367 samples of pathogenic microorganisms were collected, in which 18 256 strains of bacteria were isolated. The paper method or minimal inhibitory concentration(MIC). method were used to determine the sensitivity of antibiotics. The test and judgment standards were applied according to the Clinical & Laboratory Standards Institute(CLSI) standards of each year. WHONET5.6 software was used for statistical analysis of data. Results From 2014 to 2016, Gram-positive bacteria accounted for 24.3% and Gram-negative bacteria75.7% of clinical isolates pathogenic bacteria in Chongzuo area. The Gram-positine Racteria ranked first in the isolated pathogens from 2014 to 2016 were Staphylococcus aures, and the second were Staphlococcus epidermidis; the Gramnegatiue becteria in the isolated pathogens ranked in the top five were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacea. From 2014 to 2016, the detection rates of methi-cillin-resistant Staphylococcus aureus(MRSA) were18.3%, 24.9%, 26.0% respectively, vancomycin-resistant Enterococcus faecalis were 2.8%, 0.0%, 0.0% respectively, and vancomycin-resistant Enterococcus faecium was not detected. From 2014 to 2016, the detection rates of penicillin-resistant Streptococcus pneumoniae(PRSP) and erythromycin-resistant Streptococcus pneumoniae(ERSP) were 67.6%, 68.9%, 68.2% and 92.3%,96.5% 94.4%, respectively. The third generation of cephalosporins-, carbapenems-and quinolones-resistant Escherichia coli were 51.1%, 47.8%4, 5.2%; 0.9%, 0.7%, 0.4%; and 42.2%, 44.6%, 40.9%, respectively. The resistant rates of Klebsiella pneumoniae to the third generation of cephalosporins were 31.0%, 26.6%, 23.6%, and Klebsiella pneumoniae to carbapenems were 0.7%, 2.0%, 1.8%. The detection rates of carbapenems-resistant Pseudomonas aeruginosa and carbapenems-resistant Acinetobacter baumannii were 6.5%, 14.4%, 11.9% and 25.4%, 42.3%, 38.6% respectively. Conclusion It is serious of bacteria resistant to antibiotics in Chongzuo City. From 2014 to 2016, the detection rate of MRSA shows an increase trend, PRSP was higher than the average levels of Guangxi and China, and the drug resistance rate of carbapenems increased rapidly. Management of antimicrobial application and monitoring of bacterial resistance should be strengthened.
Objective To understand the distribution and drug resistance of pathogenic bacteria in Chongzuo City, and to grasp the situation of bacterial resistance change in this region, and provide a basis for the rational application of antibacterial drugs. Methods Data of clinical isolation pathogenic bacteria composition and drug resistance in 7 general hospitals from 2014 to 2016 were analysed. A total of 172 367 samples of pathogenic microorganisms were collected, in which 18 256 strains of bacteria were isolated. The paper method or minimal inhibitory concentration(MIC). method were used to determine the sensitivity of antibiotics. The test and judgment standards were applied according to the Clinical & Laboratory Standards Institute(CLSI) standards of each year. WHONET5.6 software was used for statistical analysis of data. Results From 2014 to 2016, Gram-positive bacteria accounted for 24.3% and Gram-negative bacteria75.7% of clinical isolates pathogenic bacteria in Chongzuo area. The Gram-positine Racteria ranked first in the isolated pathogens from 2014 to 2016 were Staphylococcus aures, and the second were Staphlococcus epidermidis; the Gramnegatiue becteria in the isolated pathogens ranked in the top five were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacea. From 2014 to 2016, the detection rates of methi-cillin-resistant Staphylococcus aureus(MRSA) were18.3%, 24.9%, 26.0% respectively, vancomycin-resistant Enterococcus faecalis were 2.8%, 0.0%, 0.0% respectively, and vancomycin-resistant Enterococcus faecium was not detected. From 2014 to 2016, the detection rates of penicillin-resistant Streptococcus pneumoniae(PRSP) and erythromycin-resistant Streptococcus pneumoniae(ERSP) were 67.6%, 68.9%, 68.2% and 92.3%,96.5% 94.4%, respectively. The third generation of cephalosporins-, carbapenems-and quinolones-resistant Escherichia coli were 51.1%, 47.8%4, 5.2%; 0.9%, 0.7%, 0.4%; and 42.2%, 44.6%, 40.9%, respectively. The resistant rates of Klebsiella pneumoniae to the third generation of cephalosporins were 31.0%, 26.6%, 23.6%, and Klebsiella pneumoniae to carbapenems were 0.7%, 2.0%, 1.8%. The detection rates of carbapenems-resistant Pseudomonas aeruginosa and carbapenems-resistant Acinetobacter baumannii were 6.5%, 14.4%, 11.9% and 25.4%, 42.3%, 38.6% respectively. Conclusion It is serious of bacteria resistant to antibiotics in Chongzuo City. From 2014 to 2016, the detection rate of MRSA shows an increase trend, PRSP was higher than the average levels of Guangxi and China, and the drug resistance rate of carbapenems increased rapidly. Management of antimicrobial application and monitoring of bacterial resistance should be strengthened.
引文
[1]侯芳,吕媛.不容忽视的细菌耐药[J].中国抗生素杂志,2017,42(3):203-206.
[2]符跃强,许峰.儿童耐甲氧西林金黄色葡萄球菌感染治疗进展[J].中华使用儿科临床杂志,2017,32(6):416-419.
[3]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[4]张铃铃,陈剑云.耐甲氧西林金黄色葡萄球菌感染的药物治疗进展[J].临床合理用药杂志,2015,8(12):169-170,179.
[5]李瑞云,查干,吴小军.革兰阳性菌血流感染菌种分布及耐药性分析[J].疑难病杂志,2017,16(6):570-574.
[6]裴双,苏建荣.耐甲氧西林金黄色葡萄球菌耐药性分析及mecA和PVL基因检测[J].临床和实验医学杂志,2017,16(1):94-97.
[7]赵文申,林丽萍,崔庆庆,等.ICU患者下呼吸道感染耐甲氧西林金黄色葡萄球菌耐药性分析[J].中国医学装备,2017,14(8):50-52.
[8]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[Z].2015.
[9]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.2015年全国细菌耐药监测报告[Z].2016.
[10]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.2016年全国细菌耐药监测报告[Z].2017.
[11]袁丽美,吴坚敏,周黎.临床分离金黄色葡萄球菌的耐药性及其对消毒剂抗性研究[J].中国消毒学杂志,2018,35(11):850-852.
[12]史文元,李胜涛,徐玉娟,等.金黄色葡萄球菌感染的临床分布与耐药性[J].检验医学与临床,2017,14(14):2089-2090.
[13]郭建军.金黄色葡萄球菌的临床分布及耐药性分析[J]中国医药指南,2017,15(11):12-13.
[14]朱吉超,魏莲花,杨永清,等.耐甲氧西林金黄色葡萄球菌临床分布及耐药性分析[J].中华医院感染学杂志,2017,27(7):1462-1465.
[15]Vasoo S,Singh K,Hsu LY,et al.Increasing antibiotic resistance in Streptococcus pneumoniae colonizing children attending day-care centres in Singapore[J].Respirology,2011,16(8):1241-1248.
[16]Weiser JN,Ferreira DM,Paton JC.Streptococcus pneumoniae:transmission,colonization and invasion[J].Nat Rev Microbiol,2018,16(6):355-467.
[17]刘民,马秋月.肺炎链球菌相关疾病流行病学研究进展[J].中国公共卫生,2018,34(11):1449-1452.
[18]Mamishi S,Moradkhani S,Mahmoudi S,et al.PenicillinResistant trend of Streptococcus pneumoniae in Asia:Asystematic review[J].Iran J Microbiol,2014,6(4):198-210.
[19]王辉.细菌耐药发展的新动态[J].传染病信息,2004,17(1):5-6.
[20]宁桂军,尹遵栋.中国肺炎球菌病疾病负担研究进展[J].中国公共卫生,2018,34(11):1453-1455.
[21]刘娜,刘永军,李子扬,等.PCV疫苗预防肺炎球菌性疾病的临床进展及经济性研究[J].现代商贸工业,2018,39(29):81-82.
[22]李彩华,陈维忠,胡晓峰,等.耐碳青霉烯类革兰阴性菌分布特征及耐药性分析[J].中华医院感染学杂志,2018,28(5):650-653.
[23]张爱荣.156株耐碳青霉烯类肺炎克雷伯菌临床分布特点及其药物敏感性检测[J].中国医药导报,2018,15(11):178-181.
[24]刘刚,魏莲花,邹凤梅,等.2011~2016年耐碳青霉烯类抗菌药物肠杆菌科细菌的分布特点和耐药性分析[J].中国医药科学,2018,8(9):20-23.
[25]Wilson AP,Livermore DM,Otter JA,et al.Prevention and control of multi-drug-resistant Gram-negative bacteria:recommendations from a Joint Working Party[J].J Hosp Infect,2016,92 Suppl 1:S1-S44.
[26]Wilson APR.Sparing carbapenem usage[J].J Antimicrob Chemother,2017,72(9):2410-2417.
[2]符跃强,许峰.儿童耐甲氧西林金黄色葡萄球菌感染治疗进展[J].中华使用儿科临床杂志,2017,32(6):416-419.
[3]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[4]张铃铃,陈剑云.耐甲氧西林金黄色葡萄球菌感染的药物治疗进展[J].临床合理用药杂志,2015,8(12):169-170,179.
[5]李瑞云,查干,吴小军.革兰阳性菌血流感染菌种分布及耐药性分析[J].疑难病杂志,2017,16(6):570-574.
[6]裴双,苏建荣.耐甲氧西林金黄色葡萄球菌耐药性分析及mecA和PVL基因检测[J].临床和实验医学杂志,2017,16(1):94-97.
[7]赵文申,林丽萍,崔庆庆,等.ICU患者下呼吸道感染耐甲氧西林金黄色葡萄球菌耐药性分析[J].中国医学装备,2017,14(8):50-52.
[8]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[Z].2015.
[9]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.2015年全国细菌耐药监测报告[Z].2016.
[10]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.2016年全国细菌耐药监测报告[Z].2017.
[11]袁丽美,吴坚敏,周黎.临床分离金黄色葡萄球菌的耐药性及其对消毒剂抗性研究[J].中国消毒学杂志,2018,35(11):850-852.
[12]史文元,李胜涛,徐玉娟,等.金黄色葡萄球菌感染的临床分布与耐药性[J].检验医学与临床,2017,14(14):2089-2090.
[13]郭建军.金黄色葡萄球菌的临床分布及耐药性分析[J]中国医药指南,2017,15(11):12-13.
[14]朱吉超,魏莲花,杨永清,等.耐甲氧西林金黄色葡萄球菌临床分布及耐药性分析[J].中华医院感染学杂志,2017,27(7):1462-1465.
[15]Vasoo S,Singh K,Hsu LY,et al.Increasing antibiotic resistance in Streptococcus pneumoniae colonizing children attending day-care centres in Singapore[J].Respirology,2011,16(8):1241-1248.
[16]Weiser JN,Ferreira DM,Paton JC.Streptococcus pneumoniae:transmission,colonization and invasion[J].Nat Rev Microbiol,2018,16(6):355-467.
[17]刘民,马秋月.肺炎链球菌相关疾病流行病学研究进展[J].中国公共卫生,2018,34(11):1449-1452.
[18]Mamishi S,Moradkhani S,Mahmoudi S,et al.PenicillinResistant trend of Streptococcus pneumoniae in Asia:Asystematic review[J].Iran J Microbiol,2014,6(4):198-210.
[19]王辉.细菌耐药发展的新动态[J].传染病信息,2004,17(1):5-6.
[20]宁桂军,尹遵栋.中国肺炎球菌病疾病负担研究进展[J].中国公共卫生,2018,34(11):1453-1455.
[21]刘娜,刘永军,李子扬,等.PCV疫苗预防肺炎球菌性疾病的临床进展及经济性研究[J].现代商贸工业,2018,39(29):81-82.
[22]李彩华,陈维忠,胡晓峰,等.耐碳青霉烯类革兰阴性菌分布特征及耐药性分析[J].中华医院感染学杂志,2018,28(5):650-653.
[23]张爱荣.156株耐碳青霉烯类肺炎克雷伯菌临床分布特点及其药物敏感性检测[J].中国医药导报,2018,15(11):178-181.
[24]刘刚,魏莲花,邹凤梅,等.2011~2016年耐碳青霉烯类抗菌药物肠杆菌科细菌的分布特点和耐药性分析[J].中国医药科学,2018,8(9):20-23.
[25]Wilson AP,Livermore DM,Otter JA,et al.Prevention and control of multi-drug-resistant Gram-negative bacteria:recommendations from a Joint Working Party[J].J Hosp Infect,2016,92 Suppl 1:S1-S44.
[26]Wilson APR.Sparing carbapenem usage[J].J Antimicrob Chemother,2017,72(9):2410-2417.