陕西省临床分离革兰阴性菌的分布与耐药分析
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摘要
目的了解全国细菌耐药监测网陕西省入网单位2014-2016年革兰阴性菌耐药情况,为该地区临床合理使用抗菌药物提供依据。方法收集陕西省42家全国细菌耐药监测网入网单位2014-2016年革兰阴性菌相关数据,采用WHONET5.6软件进行数据分析。结果 2014-2016年检出革兰阴性菌分别为29 343株[66.9%(29 343/43 830)]、32 955株[68.3%(32 955/48 258)]和43 206株[69.9%(43 206/61 819)];标本来源前5位者分别为痰液、尿液、血液、分泌物和伤口脓液。分离前5位的细菌分别为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和阴沟肠杆菌。大肠埃希菌对第3代头孢菌素耐药率分别为64.3%、61.7%和61.4%;肺炎克雷伯菌对第3代头孢菌素耐药率分别为43.0%、37.80%、32.6%;耐碳青霉烯类大肠埃希菌检出率分别为2.3%、5.7%和1.4%;耐碳青霉烯类肺炎克雷伯菌检出率分别为6.1%、8.8%、3.2%;耐碳青霉烯类铜绿假单胞菌检出率分别为32.6%、29.0%和27.4%;耐碳青霉烯类鲍曼不动杆菌检出率分别为66.2%、51.3%、58.0%。结论革兰阴性菌是临床分离的主要病原菌,其耐药现象普遍,应加强对细菌耐药的监测,及时了解细菌耐药变化趋势,有效指导临床用药。
Objective To explore the gram negative bacterial drug resistance from 2014 to 2016 in the members of Antimicrobial Resistant Investigation Net of Shaanxi province,and to guide the clinicians to use antimicrobial drugs rationally.Methods The datas of Gram-negative bacteria were collected from 2014 to2016 in the Antimicrobial Resistant Investigation Net of Shaanxi province.The datas were analyzed by software WHONET5.6.Results The Gram-negative bacterial isolates were 29 343(66.9%),32 955(68.3%)and43 206(69.9%)respectively from 2014 to 2016.The top five populations of the source were sputum,urine,blood,secretions and wound pus.From 2014 to 2016 CTX/CRO-R ECO were 64.30%,61.70%,61.40%;CTX/CRO-R KPN were 43.00%,37.80%,32.60%;CRE-ECO were 2.30%,5.70%,1.40%;CRE-KPN were6.10%,8.80%,3.20%;CRE-PAE were 32.60%,29%,27.40%;CRE-ABA were 66.20%,51.30%,58.0%.Conclusion Gram-negative bacteria are the main pathogenic bacteria of clinical separation,and the drug resistance is more common.We should strengthen the monitoring and management of bacterial resistance,and guide the clinical medication effectively.
Objective To explore the gram negative bacterial drug resistance from 2014 to 2016 in the members of Antimicrobial Resistant Investigation Net of Shaanxi province,and to guide the clinicians to use antimicrobial drugs rationally.Methods The datas of Gram-negative bacteria were collected from 2014 to2016 in the Antimicrobial Resistant Investigation Net of Shaanxi province.The datas were analyzed by software WHONET5.6.Results The Gram-negative bacterial isolates were 29 343(66.9%),32 955(68.3%)and43 206(69.9%)respectively from 2014 to 2016.The top five populations of the source were sputum,urine,blood,secretions and wound pus.From 2014 to 2016 CTX/CRO-R ECO were 64.30%,61.70%,61.40%;CTX/CRO-R KPN were 43.00%,37.80%,32.60%;CRE-ECO were 2.30%,5.70%,1.40%;CRE-KPN were6.10%,8.80%,3.20%;CRE-PAE were 32.60%,29%,27.40%;CRE-ABA were 66.20%,51.30%,58.0%.Conclusion Gram-negative bacteria are the main pathogenic bacteria of clinical separation,and the drug resistance is more common.We should strengthen the monitoring and management of bacterial resistance,and guide the clinical medication effectively.
引文
[1]李光辉,朱德妹,汪复,等.2011年中国CHINET血培养临床分离菌的分布及耐药性[J].中国感染与化疗杂志,2013,13(4):241-247.
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[8]李耘,吕媛,薛峰,等.卫生部全国细菌耐药监测网(Mohnarin)2011-2012年革兰阴性菌耐药监测报告[J].中国临床药理学杂志,2014,30(3):260-277.
[9]苏惠婷,孙坤玲,贾晓炯,等.耐三代头孢大肠埃希菌血流感染的流行病学调查和危险因素分析[J].基因组学与应用生物学,2016,35(7):1614-1622.
[10]HAYAKAWA K,GATTU S,MARCHAIM D,et al.Epidemiology and risk factors for isolation of Escherichia coli producing CTX-M-type extended-spectrumβ-lactamase in a large U.S.Medical Center[J].Antimicrob Agents Chemother,2013,57(8):4010-4018.
[11]PFEIFER Y,CULLIK A,WITTE W.Resistance to cephalosporins and carbapenems in Gram-negative bacterial pathogens[J].Int J Med Microbiol,2010,300(6):371-379.
[12]谢佳,张雪飞,肖胤勃,等.临床常见革兰阴性菌对碳青霉烯类药物耐药性检测[J].热带医学杂志,2014,14(2):158-161.
[2]陈宏斌,赵春江,王辉,等.2007-2013年医院内获得性肺炎病原菌分布及其耐药性分析[J].中华医院感染学杂志,2017,27(1):1-7.
[3]陆登辉,万霞,李婵,等.重症监护室医院获得性泌尿道感染病原菌分析[J].中国感染控制杂志,2015,14(1):63-64.
[4]归巧娣,刘文康,苍金荣,等.2013-2015年陕西省细菌耐药监测网血培养革兰阳性病原菌变迁及耐药性分析[J].现代检验医学杂志,2017,32(2):89-91.
[5]归巧娣,任健康,苍金荣,等.2012年陕西省耐药监测网ICU与非ICU病房鲍曼不动杆菌耐药监测结果[J].国际检验医学杂志,2013,34(20):2687-2688.
[6]李耘,刘健,薛峰,等.卫生部全国细菌耐药监测网(Mohnarin)2007-2008年报告[J].中国临床药理学杂志,2011,27(5):323-334.
[7]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.
[8]李耘,吕媛,薛峰,等.卫生部全国细菌耐药监测网(Mohnarin)2011-2012年革兰阴性菌耐药监测报告[J].中国临床药理学杂志,2014,30(3):260-277.
[9]苏惠婷,孙坤玲,贾晓炯,等.耐三代头孢大肠埃希菌血流感染的流行病学调查和危险因素分析[J].基因组学与应用生物学,2016,35(7):1614-1622.
[10]HAYAKAWA K,GATTU S,MARCHAIM D,et al.Epidemiology and risk factors for isolation of Escherichia coli producing CTX-M-type extended-spectrumβ-lactamase in a large U.S.Medical Center[J].Antimicrob Agents Chemother,2013,57(8):4010-4018.
[11]PFEIFER Y,CULLIK A,WITTE W.Resistance to cephalosporins and carbapenems in Gram-negative bacterial pathogens[J].Int J Med Microbiol,2010,300(6):371-379.
[12]谢佳,张雪飞,肖胤勃,等.临床常见革兰阴性菌对碳青霉烯类药物耐药性检测[J].热带医学杂志,2014,14(2):158-161.