2017年上海某三级综合中医医院住院患者细菌感染及耐药性分析
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摘要
【目的】了解2017年上海某三级综合中医医院住院患者的细菌感染及耐药情况,为临床合理选用抗菌药物提供依据。【方法】对2017年住院患者的临床标本进行药敏试验,药敏试验采用纸片扩散法,按美国临床和实验室标准协会(CLSI)2016标准判读结果。【结果】2017年共分离出1 547株细菌,其中革兰阴性菌1 222株,占79.0%;革兰阳性菌325株,占21.0%。检出细菌数居前5位的分别为大肠埃希菌(占22.2%)、肺炎克雷伯菌(占16.7%)、铜绿假单胞菌(占12.5%)、金黄色葡萄球菌(占12.3%)及鲍曼不动杆菌(占5.4%)。鲍曼不动杆菌对碳青霉烯类的耐药率较高,未发现对万古霉素、利奈唑胺、替加西林耐药的金黄色葡萄球菌。【结论】实时监测医院内细菌耐药的变化情况,可以科学指导临床使用抗菌药物并降低细菌耐药率。
[Objective] To investigate the distribution of conditioned pathogenic bacteria and their resistance to anti-bacterial drugs at a class A TCM(traditional chinese medicine) hospital in 2017 in order to provide a reference for the prevention and control of hospital infection and clinically rational selection of anti-bacterial drugs. [Methods] The drug sensitivity test was carried out by paper diffusion method,and the results were read according to the standard of CLSI 2016. [Results] A total of 1 547 clinical isolates were collected,of which the top 5 pathogenic bacteria were Escherichia coli(22.2%),Klebsiella pneumonia(16.7%),Pseudomonas aeruginosa(12.5%),Staphylococcus aureus(12.3%) and Acinetobacter baumannii(5.4%).The resistance rate of Acinetobacter bauman to carbapenems was higher.No Staphylococcus aureus was found to be resistant to vancomycin,linezolid and tegocycline. [Conclusion] Dynamic monitoring of bacterial resistance changes in the region has important significance for guiding the rational selection of anti-bacterials and reducing the rate of bacterial resistance.
[Objective] To investigate the distribution of conditioned pathogenic bacteria and their resistance to anti-bacterial drugs at a class A TCM(traditional chinese medicine) hospital in 2017 in order to provide a reference for the prevention and control of hospital infection and clinically rational selection of anti-bacterial drugs. [Methods] The drug sensitivity test was carried out by paper diffusion method,and the results were read according to the standard of CLSI 2016. [Results] A total of 1 547 clinical isolates were collected,of which the top 5 pathogenic bacteria were Escherichia coli(22.2%),Klebsiella pneumonia(16.7%),Pseudomonas aeruginosa(12.5%),Staphylococcus aureus(12.3%) and Acinetobacter baumannii(5.4%).The resistance rate of Acinetobacter bauman to carbapenems was higher.No Staphylococcus aureus was found to be resistant to vancomycin,linezolid and tegocycline. [Conclusion] Dynamic monitoring of bacterial resistance changes in the region has important significance for guiding the rational selection of anti-bacterials and reducing the rate of bacterial resistance.
引文
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[2]GOULD I M,BAL A M.New antibiotic agents in the pipeline and how they can help overcome microbial resistance[J].Virulence,2013,4(2):185-191.
[3]LUSHNIAK B D.Antibiotic resistance:a public health crisis[J].Public Health Rep,2014,129(4):314-316.
[4]白晓,许霞,曾宪飞.不同临床科室间ESBLs大肠埃希菌耐药情况分析[J].检验医学与临床,2016,13(15):2178-2180.
[5]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.
[6]张静,喻玮,赵丽娜,等.我国细菌耐药现状与特征[J].中华临床感染病杂志,2016,9(2):118-128.
[7]朱秋丽,糜琛蓉,朱仁义.上海市6所二级医院住院患者细菌耐药监测情况分析[J].中国消毒学杂志,2017,34(3):257-260.
[8]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015—2016革兰氏阴性菌监测报告[J].中国临床药理学杂志,2017,33(23):2521-2542.
[9]王作艳,余娟娟,陈峰英.某中医院住院患者感染病原菌种类分布及耐药性研究[J].中国消毒学杂志,2016,33(4):335-337.
[10]郭玉红,宫晶书,刘东国,等.2014—2016年北京地区3家三甲中医医院细菌耐药监测分析[J].世界中医药,2017,12(4):721-724.
[11]王惠姣,徐娇君,陈小平,等.ICU患者感染多药耐药肺炎克雷伯菌的耐药性分析[J].中华医院感染学杂志,2016,26(6):1235-1237,1240.
[12]李晓红,郭宁辉,杨婧,等.某医院ICU住院患者鲍曼不动杆菌流行特征与耐药性分析[J].中国消毒学杂志,2016,33(4):338-340.
[13]磨国鑫.鲍曼不动杆菌感染的临床病例特点、耐药特征及暴发流行模式的分析[D].北京:中国人民解放军军事医学科学院,2009.
[14]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015—2016革兰氏阳性菌监测报告[J].中国临床药理学杂志,2017,33(23):2543-2556.
[15]许建文,史道华.万古霉素耐药肠球菌耐药机制的研究进展[J].中国抗生素杂志,2016,41(5):329-334.
[16]关于印发遏制细菌耐药国家行动计划(2016—2020年)的通知[J].中华人民共和国国家卫生和计划生育委员会公报,2016(8):14-17.