2017年山东省立医院细菌耐药性监测
|
摘要
目的了解山东省立医院2017年临床分离细菌对抗菌药物的耐药性。方法采用纸片扩散法或VITEK 2-Compact仪器法测定分离株的药物敏感性,参照CLSI 2017年版和EUCAST折点判读结果,使用WHONET 5.6软件统计分析。结果2017年共收集非重复临床分离菌4725株,其中革兰阴性菌3301株(69.9%),革兰阳性菌1424株(30.1%)。病原菌标本来自呼吸道所占比率最高(39.3%),其次为皮肤软组织标本(21.2%)和尿液(19.5%)。分离菌中排在前5位的依次为大肠埃希菌(21.4%)、克雷伯菌属(11.0%)、铜绿假单胞菌(10.9%)、金黄色葡萄球菌(10.8%)和不动杆菌属(7.9%)。大肠埃希菌和克雷伯菌属中ESBL检出率分别为53.5%和36.5%。碳青霉烯类耐药的大肠埃希菌和肺炎克雷伯菌分别占各自菌种的1.5%和6.2%。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为29.8%和23.2%。鲍曼不动杆菌除对替加环素、头孢哌酮-舒巴坦和甲氧苄啶-磺胺甲唑的耐药率为9.2%、39.5%和39.2%外,对其他抗菌药物的耐药率均在50%以上。流感嗜血杆菌和卡他莫拉菌中的β内酰胺酶阳性率分别为56.9%和100%。金黄色葡萄球菌中MRSA的检出率为29.5%,未发现对万古霉素和利奈唑胺耐药的葡萄球菌属。屎肠球菌对多数抗菌药物的耐药率均高于粪肠球菌,发现4株万古霉素耐药屎肠球菌。共分离肺炎链球菌178株,其中134株(75.3%)来自儿科病房;非脑脊液分离株未发现青霉素耐药菌株,其他溶血链球菌对青霉素、头孢菌素和万古霉素均较敏感。结论细菌耐药性呈增高趋势,应重视细菌耐药性监测并加强抗生素的合理使用。
Objective To investigate the antibiotic resistance of clinical isolates in Shangdong Provincial Hospital during 2017.Methods The antimicrobial susceptibility of clinical isolates was tested by using VITEK 2-Compact or disk diffusion method.All the data were analyzed by WHONET 5.6 software according to CLSI 2017 breakpoints. Results A total of 4 725 nonduplicate clinical strains were collected during 2017, of which gram negative rods and gram positive cocci accounted for 69.9% and 30.1%,respectively. The most common specimen source was respiratory tract(39.3%), followed by skin and soft tissue specimens(21.2%),and urine(19.5%). Escherichia coli was the most frequently isolated bacteria, followed by Klebsiella spp., Pseudomonas aeruginosa,Staphylococcus aureus, and Acinetobacter spp., accounting for 21.4%, 11.0%, 10.9%, 10.8% and 7.9%, respectively. The prevalence of ESBL-positive strains was 53.5% in E. coli and 36.5% in Klebsiella pneumoniae, respectively. The prevalence of carbapenemresistant strains was 1.5% in E. coli and 6.2% in Klebsiella pneumoniae, respectively. The percentage of Pseudomonas aeruginosa resistant to imipenem and meropenem was 29.8% and 23.2%,respectively. The percentage of Acinetobacter baumannii strains resistant to the antibiotics tested was all above 50%except cefoperazone-sulbactam(39.5%), tigecycline(9.2%),and trimethoprim-sulfamethoxazole(39.2%). The positive rate of beta-lactamase was 56.9% in Haemophilus influenzae and100% in Moraxelle catarrhalis. The prevalence of methicillinresistant Staphylococcus aureus(MRSA) was 29.5%. No strains were found resistant to vancomycin or linezolid in Staphylococcus.The percentage of Enterococcus faecium resistant to most antibiotics tested was higher than that of Enterococcus faecalis. Four strains of Enterococcus faecium was found resistant to vancomycin. A total of 178 Streptococcus pneumoniae were isolated, of which 134(75.3%) were from pediatric wards. No non-meningitis strain was found resistant to penicillin. Other Streptococcus were sensitive to penicillin, cephalosporin and vancomycin. Conclusions Antibiotic resistance is a growing trend in bacterial isolates. We should pay more attention to strengthen antimicrobial resistance surveillance and improve the rational use of antibiotics.
Objective To investigate the antibiotic resistance of clinical isolates in Shangdong Provincial Hospital during 2017.Methods The antimicrobial susceptibility of clinical isolates was tested by using VITEK 2-Compact or disk diffusion method.All the data were analyzed by WHONET 5.6 software according to CLSI 2017 breakpoints. Results A total of 4 725 nonduplicate clinical strains were collected during 2017, of which gram negative rods and gram positive cocci accounted for 69.9% and 30.1%,respectively. The most common specimen source was respiratory tract(39.3%), followed by skin and soft tissue specimens(21.2%),and urine(19.5%). Escherichia coli was the most frequently isolated bacteria, followed by Klebsiella spp., Pseudomonas aeruginosa,Staphylococcus aureus, and Acinetobacter spp., accounting for 21.4%, 11.0%, 10.9%, 10.8% and 7.9%, respectively. The prevalence of ESBL-positive strains was 53.5% in E. coli and 36.5% in Klebsiella pneumoniae, respectively. The prevalence of carbapenemresistant strains was 1.5% in E. coli and 6.2% in Klebsiella pneumoniae, respectively. The percentage of Pseudomonas aeruginosa resistant to imipenem and meropenem was 29.8% and 23.2%,respectively. The percentage of Acinetobacter baumannii strains resistant to the antibiotics tested was all above 50%except cefoperazone-sulbactam(39.5%), tigecycline(9.2%),and trimethoprim-sulfamethoxazole(39.2%). The positive rate of beta-lactamase was 56.9% in Haemophilus influenzae and100% in Moraxelle catarrhalis. The prevalence of methicillinresistant Staphylococcus aureus(MRSA) was 29.5%. No strains were found resistant to vancomycin or linezolid in Staphylococcus.The percentage of Enterococcus faecium resistant to most antibiotics tested was higher than that of Enterococcus faecalis. Four strains of Enterococcus faecium was found resistant to vancomycin. A total of 178 Streptococcus pneumoniae were isolated, of which 134(75.3%) were from pediatric wards. No non-meningitis strain was found resistant to penicillin. Other Streptococcus were sensitive to penicillin, cephalosporin and vancomycin. Conclusions Antibiotic resistance is a growing trend in bacterial isolates. We should pay more attention to strengthen antimicrobial resistance surveillance and improve the rational use of antibiotics.
引文
[1]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].2017,M100-S27.
[2]邵春红,金炎,刘义刚,等.2013年山东省立医院细菌耐药性监测[J].中国感染与化疗杂志,2015,15(2):126-133.
[3]张裕珍,张琳,金炎,等.2016年山东省立医院细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):576-583.
[4]JIN Y,SHAO C,LI J,et al.Outbreak of multidrug resistant NDM-1-producing Klebsiella pneumoniae from a neonatal unit in Shandong Province,China[J].PLoS One,2015,10(3):e0119571.
[5]JIN Y,SONG X,LIU Y,et al.Characteristics of carbapenemase-producing Klebsiella pneumoniae as a cause of neonatal infection in Shandong,China[J].Exp Ther Med,2017,13(3):1117-1126.
[6]OKAMOTO K,L I N M Y,HAVERKATE M,e t a l.Modifiable risk factors for the spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae among long-term acute-care hospital patients[J].Infect Control Hosp Epidemiol,2017,38(6):670-677.
[7]TEERAWATTANAPONG N,PANICH P,KULPOKIN D,et al.A systematic review of the burden of multidrug-resistant healthcare-associated infections among intensive care unit patients in southeast Asia:the rise of multidrug-resistant Acinetobacter baumannii[J].Infect Control Hosp Epidemiol,2018,39(5):525-533.
[8]王丽萍,张仁峰,范会,等.2011-2015年山东省某院金黄色葡萄球菌耐药情况分析[J].齐鲁医学杂志,2017,32(3):297-300.
[9]REMSCHMIDT C,SCHR?DER C,BEHNKE M,et al.Continuous increase of vancomycin resistance in enterococci causing nosocomial infections in Germany-10 years of surveillance[J].Antimicrob Resist Infect Control,2018,7(24):54.
[2]邵春红,金炎,刘义刚,等.2013年山东省立医院细菌耐药性监测[J].中国感染与化疗杂志,2015,15(2):126-133.
[3]张裕珍,张琳,金炎,等.2016年山东省立医院细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):576-583.
[4]JIN Y,SHAO C,LI J,et al.Outbreak of multidrug resistant NDM-1-producing Klebsiella pneumoniae from a neonatal unit in Shandong Province,China[J].PLoS One,2015,10(3):e0119571.
[5]JIN Y,SONG X,LIU Y,et al.Characteristics of carbapenemase-producing Klebsiella pneumoniae as a cause of neonatal infection in Shandong,China[J].Exp Ther Med,2017,13(3):1117-1126.
[6]OKAMOTO K,L I N M Y,HAVERKATE M,e t a l.Modifiable risk factors for the spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae among long-term acute-care hospital patients[J].Infect Control Hosp Epidemiol,2017,38(6):670-677.
[7]TEERAWATTANAPONG N,PANICH P,KULPOKIN D,et al.A systematic review of the burden of multidrug-resistant healthcare-associated infections among intensive care unit patients in southeast Asia:the rise of multidrug-resistant Acinetobacter baumannii[J].Infect Control Hosp Epidemiol,2018,39(5):525-533.
[8]王丽萍,张仁峰,范会,等.2011-2015年山东省某院金黄色葡萄球菌耐药情况分析[J].齐鲁医学杂志,2017,32(3):297-300.
[9]REMSCHMIDT C,SCHR?DER C,BEHNKE M,et al.Continuous increase of vancomycin resistance in enterococci causing nosocomial infections in Germany-10 years of surveillance[J].Antimicrob Resist Infect Control,2018,7(24):54.