428株呼吸道革兰阳性菌的临床分布及耐药性趋势分析
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摘要
目的分析2018年威海地区加入细菌耐药监测网的8家医院中呼吸道来源的革兰阳性(G~+病原菌临床分布情况及耐药趋势,为临床医师合理选择抗菌药物提供理论依据。方法 8家入网医院(3家三级甲等综合性医院、3家专科三级甲等医院、2家二级甲等医院)参照统一方案进行细菌耐药性监测,细菌的药敏试验采用纸片扩散法(K-B法)、自动化仪器法和E试验法,按照美国临床实验室标准化协会(CLSI)2017年标准判读检测结果,用Whonet 5.6软件统计分析呼吸道标本分离菌的分布及耐药性。结果 2018年8家医院共分离出428株G~+细菌,前3位依次为金黄色葡萄球菌(63.1%)、肺炎链球菌(23.3%)、凝固酶阴性葡萄球菌(7.0%)。分离菌的药敏试验结果显示:肺炎链球菌和化脓链球菌对红霉素、克林霉素的耐药率均>80%,但对氟喹诺酮类、万古霉素、利奈唑胺却有较高的敏感性;金黄色葡萄球菌中未检出对万古霉素、利奈唑胺耐药的菌株。8家医院耐甲氧西林金黄色葡萄球菌(MRSA)平均检出率为19.0%,明显低于2017年全国金黄色葡萄球菌检出率(32.2%)。结论金黄色葡萄球菌和肺炎链球菌是呼吸道标本分离培养得到的主要G~+细菌,存在较为广泛的耐药性,临床医师应充分了解抗菌药物的当地流行病学耐药情况决定经验治疗,并根据当地的实际药敏培养结果合理选择相应的抗菌药物,已达到减少耐药菌株产生的目的。
Objective To provide theoretical basis for clinicians to reasonably select bactericidal drugs,the clinical distribution and drug resistance trend of gram-positive(G~+) pathogenic bacteria from respiratory tract sources in hospitals in Weihai region were analyzed. Methods The 8 hospitals in the bacterial drug resistance monitoring network in Weihai region in 2018(including 3 third grade A comprehensive hospital, 4 third grade A specialized hospital, 1 second grade A hospital) carried out bacterial drug resistance surveillance with a reference of a unified approach, applied the disc diffusion method(K-B method), automation instrument method and E test method to perform bacterial susceptibility tests, interpreted the obtained results according to the standards in American Clinical Laboratory Standardization Institute(CLSI) in 2017, and used Whonet 5.6 software for statistical analysis of the distribution and drug resistance of the isolated bacteria from respiratory tract specimens. Results In 2018,a total of 428 G~+ bacteria strains were isolated from the 8 hospitals. The top 3 strains were Staphylococcus aureus(63.1%), Streptococcus pneumoniae(23.3%), and coagulase-negative Staphylococcus aureus(7.0%). The results of drug sensitivity test of isolated bacteria showed that the drug resistance rates to erythromycin and clindamycin of Streptococcus pneumoniae and Streptococcus pyogenes were all more than 80%, but they were highly sensitive to fluoroquinolones, vancomycin and linezolid; the strains of Staphylococcus aureus in the isolates were not resistant to vancomycin and linezolid. The average detection rate of methicillin-resistant Staphylococcus aureus(MRSA) in the8 hospitals was 19.0%, significantly lower than that of staphylococcus aureus in 2017(32.2%) in the whole country.Conclusions Staphylococcus aureus and Streptococcus pneumoniae are the main G~+ pathogens isolated from the cultures of respiratory tract specimens, and the tests of drug resistance show that the above main pathogens have a wide range of drug resistance. The clinicians should fully understand the local epidemiological resistance situations of anti-bacterial drug to determine the treatment, and based on the actual local drug susceptibility test results of the pathogenic isolate from cultivation,the corresponding antibiotics are reasonably chosen in order to achieve the purpose of reducing the generation of drug resistant strains.
Objective To provide theoretical basis for clinicians to reasonably select bactericidal drugs,the clinical distribution and drug resistance trend of gram-positive(G~+) pathogenic bacteria from respiratory tract sources in hospitals in Weihai region were analyzed. Methods The 8 hospitals in the bacterial drug resistance monitoring network in Weihai region in 2018(including 3 third grade A comprehensive hospital, 4 third grade A specialized hospital, 1 second grade A hospital) carried out bacterial drug resistance surveillance with a reference of a unified approach, applied the disc diffusion method(K-B method), automation instrument method and E test method to perform bacterial susceptibility tests, interpreted the obtained results according to the standards in American Clinical Laboratory Standardization Institute(CLSI) in 2017, and used Whonet 5.6 software for statistical analysis of the distribution and drug resistance of the isolated bacteria from respiratory tract specimens. Results In 2018,a total of 428 G~+ bacteria strains were isolated from the 8 hospitals. The top 3 strains were Staphylococcus aureus(63.1%), Streptococcus pneumoniae(23.3%), and coagulase-negative Staphylococcus aureus(7.0%). The results of drug sensitivity test of isolated bacteria showed that the drug resistance rates to erythromycin and clindamycin of Streptococcus pneumoniae and Streptococcus pyogenes were all more than 80%, but they were highly sensitive to fluoroquinolones, vancomycin and linezolid; the strains of Staphylococcus aureus in the isolates were not resistant to vancomycin and linezolid. The average detection rate of methicillin-resistant Staphylococcus aureus(MRSA) in the8 hospitals was 19.0%, significantly lower than that of staphylococcus aureus in 2017(32.2%) in the whole country.Conclusions Staphylococcus aureus and Streptococcus pneumoniae are the main G~+ pathogens isolated from the cultures of respiratory tract specimens, and the tests of drug resistance show that the above main pathogens have a wide range of drug resistance. The clinicians should fully understand the local epidemiological resistance situations of anti-bacterial drug to determine the treatment, and based on the actual local drug susceptibility test results of the pathogenic isolate from cultivation,the corresponding antibiotics are reasonably chosen in order to achieve the purpose of reducing the generation of drug resistant strains.
引文
1 Rodrigo-Troyano A,Sibila O.The respiratory threat posed by multidrug resistant Gram-negative bacteria[J].Respirology,2017,22(7):1288-1299.DOI:10.1111/resp.13115.
2王陈龙,曾庆洋,冯洁娥,等.某院100株下呼吸道感染致病菌的分布及其对抗菌药物的耐药情况分析[J].抗感染药学,2018,15(6):954-956.DOI:10.13493/j.issn.1672-7878.2018.06-009.
3 Veeraraghavan B,Jesudason MR,Prakasah JAJ,et al.Antimicrobial susceptibility profiles of gram-negative bacteria causing infections collected across India during 2014-2016:Study for monitoring antimicrobial resistance trend report[J].Indian J Med Microbiol,2018,36(1):32-36.DOI:10.4103/ijmm.IJMM_17_415.
4 Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing;twenty-first informational supplement[S].2017,M100-S21.
5吴传湘,周康仕.老年人下呼吸道感染病原菌及耐药性分析[J].中国处方药,2018,16(1):44-45.DOI:10.3969/j.issn.1671-945X.2018.01.028.
6闫文萍,李俊洁,张敬治,等.耐甲氧西林葡萄球菌的临床感染特点及抗菌药物应用分析[J].实用检验医师杂志,2016,8(3):138-141.DOI:10.3969/j.issn.1674-7151.2016.03.003.
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.DOI:10.16718/j.1009-7708.2017.05.001.
8孙宏莉,陈玲,陈绪林,等.2013-2014年中国二级医院社区获得性呼吸道感染病原菌耐药性监测[J].中华结核和呼吸杂志,2016,39(1):30-37.DOI:10.3760/cma.j.issn.1001-0939.2016.01.009.
9 Torres A,Liapikou A.Levofloxacin for the treatment of respiratory tract infections[J].Expert Opin Pharmacother,2012,13(8):1203-1212.DOI:10.1517/14656566.2012.688952.
10闫东辉.β溶血链球菌药敏试验如何进行质量控制?[J].中华检验医学杂志,2006,29(1):94.(收稿日期:2019-05-05)
2王陈龙,曾庆洋,冯洁娥,等.某院100株下呼吸道感染致病菌的分布及其对抗菌药物的耐药情况分析[J].抗感染药学,2018,15(6):954-956.DOI:10.13493/j.issn.1672-7878.2018.06-009.
3 Veeraraghavan B,Jesudason MR,Prakasah JAJ,et al.Antimicrobial susceptibility profiles of gram-negative bacteria causing infections collected across India during 2014-2016:Study for monitoring antimicrobial resistance trend report[J].Indian J Med Microbiol,2018,36(1):32-36.DOI:10.4103/ijmm.IJMM_17_415.
4 Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing;twenty-first informational supplement[S].2017,M100-S21.
5吴传湘,周康仕.老年人下呼吸道感染病原菌及耐药性分析[J].中国处方药,2018,16(1):44-45.DOI:10.3969/j.issn.1671-945X.2018.01.028.
6闫文萍,李俊洁,张敬治,等.耐甲氧西林葡萄球菌的临床感染特点及抗菌药物应用分析[J].实用检验医师杂志,2016,8(3):138-141.DOI:10.3969/j.issn.1674-7151.2016.03.003.
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.DOI:10.16718/j.1009-7708.2017.05.001.
8孙宏莉,陈玲,陈绪林,等.2013-2014年中国二级医院社区获得性呼吸道感染病原菌耐药性监测[J].中华结核和呼吸杂志,2016,39(1):30-37.DOI:10.3760/cma.j.issn.1001-0939.2016.01.009.
9 Torres A,Liapikou A.Levofloxacin for the treatment of respiratory tract infections[J].Expert Opin Pharmacother,2012,13(8):1203-1212.DOI:10.1517/14656566.2012.688952.
10闫东辉.β溶血链球菌药敏试验如何进行质量控制?[J].中华检验医学杂志,2006,29(1):94.(收稿日期:2019-05-05)