2016—2017年河北省二级医院血液标本细菌分布及耐药性分析
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摘要
目的了解河北省二级医院血标本分离菌的分布及其对抗菌药物的耐药情况。方法收集河北省细菌耐药监测网二级医院2016-2017年血标本分离细菌的药物敏感数据,依据CLSI 2016年标准判定结果,应用WHONET 5.6软件进行数据分析。结果血培养共收集细菌2 909株,其中革兰阴性菌1 684株(57.9%),革兰阳性菌1 225株(42.1%)。耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌检出率分别为50.0%和72.1%。葡萄球菌属中未发现对万古霉素、替考拉宁、利奈唑胺耐药的菌株。粪肠球菌和屎肠球菌对万古霉素耐药率分别为2.7%和1.8%,两者对替考拉宁和利奈唑胺的耐药率均为0。大肠埃希菌超广谱β-内酰胺酶(extendedspectrum beta-lactamases,ESBL)的分离率为50.3%,肺炎克雷伯菌ESBL的分离率为26.2%。大肠埃希菌对亚胺培南和美罗培南的耐药率分别为6.1%和1.0%;肺炎克雷伯菌对亚胺培南和美罗培南的耐药率为5.7%和6.2%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率均为34.0%,对其他检测抗生素的耐药率均低于30.0%;鲍曼不动杆菌对亚胺培南和美罗培南的耐药率为34.0%和42.5%。结论血标本分离细菌菌种不断变化,评估不同细菌的致病性对于临床诊治非常重要,不同菌种对常用抗菌药物有不同程度的耐药,应根据药物敏感结果合理选择抗菌药物。
Objective To investigate the pathogen distribution of blood samples isolated from second-grade hospitals in Hebei and their resistance to antibiotics. Methods Drug resistance data of isolated bacteria of blood sample from second-grade hospitals during 2016—2017 were analysed by Whonet 5.6 software according to CLSI 2016.Results A total of 2 909 strains of bacteria were collected by blood culture,of which 1 684 strains were G-strains(57.9%)and 1 225 strains were G+strains(42.1%).Methicillin-resistant S.aureus(MRSA)and coagulase-negative Staphylococcus(MRCNS)accounted for 50.0%and 72.1%,respectively.No staphylococcal strains were found resistant to vancomycin,teicoplanin or linezolid.The resistance rates of E.faecalis and E.faecium to vancomycin were 2.7%and 1.8%,respectively.Both of these two kinds of strain have no resistance to teicoplanin or linezolid.The prevalence of ESBL-producing of E.coli and K.pneumonia were 50.3%and 26.2%,respectively.Resistance rates of E.coli to imipenem and meropenem were 6.1%and 1.0%,respectively.Resistance rates of K.pneumoniae to imipenem and meropenem were 5.7% and 6.2%,respectively.The resistance rates of P.aeruginosa to imipenem and meropenem were both 34.0%.The resistance rates of other antibiotics for P.aeruginosa were lower than 30.0%.The Resistance rates of A.baumannii strains to imipenem and meropenem were 34.0% and 42.5%.Conclusion It is important to evaluate the pathogenicity of different bacteria for clinical diagnosis and treatment.The pathogens isolated from blood specimens are diverse showing various levels of resistance to common antimicrobial agents.Antibiotics should be prescribed reasonably according to local susceptibility testing data.
Objective To investigate the pathogen distribution of blood samples isolated from second-grade hospitals in Hebei and their resistance to antibiotics. Methods Drug resistance data of isolated bacteria of blood sample from second-grade hospitals during 2016—2017 were analysed by Whonet 5.6 software according to CLSI 2016.Results A total of 2 909 strains of bacteria were collected by blood culture,of which 1 684 strains were G-strains(57.9%)and 1 225 strains were G+strains(42.1%).Methicillin-resistant S.aureus(MRSA)and coagulase-negative Staphylococcus(MRCNS)accounted for 50.0%and 72.1%,respectively.No staphylococcal strains were found resistant to vancomycin,teicoplanin or linezolid.The resistance rates of E.faecalis and E.faecium to vancomycin were 2.7%and 1.8%,respectively.Both of these two kinds of strain have no resistance to teicoplanin or linezolid.The prevalence of ESBL-producing of E.coli and K.pneumonia were 50.3%and 26.2%,respectively.Resistance rates of E.coli to imipenem and meropenem were 6.1%and 1.0%,respectively.Resistance rates of K.pneumoniae to imipenem and meropenem were 5.7% and 6.2%,respectively.The resistance rates of P.aeruginosa to imipenem and meropenem were both 34.0%.The resistance rates of other antibiotics for P.aeruginosa were lower than 30.0%.The Resistance rates of A.baumannii strains to imipenem and meropenem were 34.0% and 42.5%.Conclusion It is important to evaluate the pathogenicity of different bacteria for clinical diagnosis and treatment.The pathogens isolated from blood specimens are diverse showing various levels of resistance to common antimicrobial agents.Antibiotics should be prescribed reasonably according to local susceptibility testing data.
引文
[1]陈萍,刘丁,方清永,等.多重耐药致导管相关性血流感染调查分析[J].中国抗生素杂志,2013,38(4):285-288.
[2]刘永芳,陈金文,周凤,等.血流感染病原菌构成及其多重耐药性分析[J].中国抗生素杂志,2017,42(12):1056-1060.
[3]李光辉,朱德妹,汪复,等.2012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,2014,14(6):474-481.
[4]田磊,陈中举,李丽,等.2012年湖北省成人患者血培养分离菌耐药性分析[J].中国感染与化疗杂志,2015,15(6):509-516.
[5]查翔远,潘晓龙,胡志军,等.2010-2014年血培养分离菌的分布及耐药性分析[J].中国感染与化疗杂志,2016,16(5):602-607.
[6]高丽钦,王武军,甘龙杰,等.2011-2013年临床血培养病原菌的分布及耐药性变迁[J].中国抗生素杂志,2015,40(7):555-560.
[7]郭燕,朱德妹,胡付品,等.2016年上海市细菌耐药性监测[J].中国感染与化疗杂志,2017,17(6):609-622.
[8]郭燕,吴湜,傅祝英杰,等.血液和无菌体液分离金黄色葡萄球菌抗菌药物的敏感性及毒力基因检测[J].中国感染与化疗杂志,2017,17(2):127-133.
[9]Cui L,Wang Y,Lv Y,et al.Nationwide surveillance of novel oxazolidinone resistance gene optrA in enterococcus isolates in China from 2004to 2014[J].Antimicrob Agents Chemother,2016,60(12):7490-7493.
[10]江胜娟,陈芳,李丽.西宁市某医院3287份血培养病原菌的分布及耐药性分析[J].医学动物防制,2017,33(2):147-150.
[11]胡付品.2005-2014年CHINET中国细菌耐药性监测网5种重要临床分离菌的耐药性变迁[J].中国感染与化疗杂志,2017,17(1):93-99.
[12]赵文申,李守霞,时东彦,等.2013年河北省细菌耐药监测网三级甲等医院临床分离肺炎克雷伯菌耐药性监测[J].临床荟萃,2015,30(9):978-980.
[13]杨靖,时东彦,赵建宏,等.不同底物在CIM试验检测革兰阴性杆菌碳青霉烯酶中的应用评价[J].临床检验杂志,2016,34(8):575-578.
[14]马玉兰,宋文杰,梁屹,等.CIM与mCIM筛选肠杆菌细菌产碳青霉烯酶能力比较[J].河北医科大学学报,2018,39(8):943-948.
[15]王翠翠,张静,金炎,等.2013-2014年山东省细菌耐药监测网血液标本细菌分布及耐药性分析[J].中国感染与化疗杂志,2016,16(6):706-715.
[16]周文杰,杨小娟,王晓红,等.鲍曼不动杆菌血流感染死亡预后因素分析[J].中国急救医学,2016,36(3):234-237.
[2]刘永芳,陈金文,周凤,等.血流感染病原菌构成及其多重耐药性分析[J].中国抗生素杂志,2017,42(12):1056-1060.
[3]李光辉,朱德妹,汪复,等.2012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,2014,14(6):474-481.
[4]田磊,陈中举,李丽,等.2012年湖北省成人患者血培养分离菌耐药性分析[J].中国感染与化疗杂志,2015,15(6):509-516.
[5]查翔远,潘晓龙,胡志军,等.2010-2014年血培养分离菌的分布及耐药性分析[J].中国感染与化疗杂志,2016,16(5):602-607.
[6]高丽钦,王武军,甘龙杰,等.2011-2013年临床血培养病原菌的分布及耐药性变迁[J].中国抗生素杂志,2015,40(7):555-560.
[7]郭燕,朱德妹,胡付品,等.2016年上海市细菌耐药性监测[J].中国感染与化疗杂志,2017,17(6):609-622.
[8]郭燕,吴湜,傅祝英杰,等.血液和无菌体液分离金黄色葡萄球菌抗菌药物的敏感性及毒力基因检测[J].中国感染与化疗杂志,2017,17(2):127-133.
[9]Cui L,Wang Y,Lv Y,et al.Nationwide surveillance of novel oxazolidinone resistance gene optrA in enterococcus isolates in China from 2004to 2014[J].Antimicrob Agents Chemother,2016,60(12):7490-7493.
[10]江胜娟,陈芳,李丽.西宁市某医院3287份血培养病原菌的分布及耐药性分析[J].医学动物防制,2017,33(2):147-150.
[11]胡付品.2005-2014年CHINET中国细菌耐药性监测网5种重要临床分离菌的耐药性变迁[J].中国感染与化疗杂志,2017,17(1):93-99.
[12]赵文申,李守霞,时东彦,等.2013年河北省细菌耐药监测网三级甲等医院临床分离肺炎克雷伯菌耐药性监测[J].临床荟萃,2015,30(9):978-980.
[13]杨靖,时东彦,赵建宏,等.不同底物在CIM试验检测革兰阴性杆菌碳青霉烯酶中的应用评价[J].临床检验杂志,2016,34(8):575-578.
[14]马玉兰,宋文杰,梁屹,等.CIM与mCIM筛选肠杆菌细菌产碳青霉烯酶能力比较[J].河北医科大学学报,2018,39(8):943-948.
[15]王翠翠,张静,金炎,等.2013-2014年山东省细菌耐药监测网血液标本细菌分布及耐药性分析[J].中国感染与化疗杂志,2016,16(6):706-715.
[16]周文杰,杨小娟,王晓红,等.鲍曼不动杆菌血流感染死亡预后因素分析[J].中国急救医学,2016,36(3):234-237.