2013-2018年某医院大肠埃希菌对常用抗菌药物敏感性分析
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摘要
目的 了解某医院近6年来大肠埃希菌的检出情况及对临床主要使用抗菌药物的敏感性,为临床经验用药提供依据。方法 回顾性分析医院2013年1月-2018年12月临床分离的1 564份大肠埃希菌标本分布及其对医院主要使用抗菌药物的敏感情况。结果 2013年1月-2018年12月医院共分离出大肠埃希菌1 564株,分离率7.57%(1 564/20 670),大肠埃希菌的分离主要来自尿标本占53.64%(839/1 564)。医院主要使用抗菌药物自2015年起逐年增长,自2013年起,大肠埃希菌对美罗培南、哌拉西林/他唑巴坦的敏感率有下降趋势(P<0.001),大肠埃希菌对哌拉西林/他唑巴坦和左氧氟沙星的敏感度与其用量呈负相关性,差异有统计学意义(P<0.05)。结论 大肠埃希菌耐药情况不容乐观,抗菌药物的不合理使用或滥用可能会进一步加剧其耐药的产生,建议临床经验性使用抗菌药物时需谨慎选择。
OBJECTIVE To investigate the distribution of Escherichia coli and the sensitivity to the main antimicrobial agents in our hospital in the past 6 years, so as to provide scientific basis for clinical anti-infection treatment. METHODS The distribution of the 1 564 strains of clinically isolated Escherichia coli in our hospital from Jan. 2013 to Dec. 2018 and their sensitivity to the main antimicrobial agents were retrospectively analyzed. RESULTS A total of 1 564 strains of E coli were isolated from the hospital during Jan. 2013-Dec. 2018, with an isolation rate of 7.57%(1 564/20 670). The isolation of E coli was mainly from urine specimens, and the composition ratio was 53.64%(839/1564). The use of main antibacterial drugs in this hospital has been increasing since 2015. Since 2013, the sensitivity of E coli to meropenem, piperacillin/tazobactam has decreased(P<0.001), and the sensitivity of E coli to piperacillin/tazobactam and levofloxacin was negatively correlated to its usage amount, and the difference was significant(P<0.05). CONCLUSION The drug resistance of E coli is not optimistic. The unreasonable use or abuse of antibiotics may further aggravate the emergence of drug resistance. It is recommended to select with caution when using antibiotics in clinic.
OBJECTIVE To investigate the distribution of Escherichia coli and the sensitivity to the main antimicrobial agents in our hospital in the past 6 years, so as to provide scientific basis for clinical anti-infection treatment. METHODS The distribution of the 1 564 strains of clinically isolated Escherichia coli in our hospital from Jan. 2013 to Dec. 2018 and their sensitivity to the main antimicrobial agents were retrospectively analyzed. RESULTS A total of 1 564 strains of E coli were isolated from the hospital during Jan. 2013-Dec. 2018, with an isolation rate of 7.57%(1 564/20 670). The isolation of E coli was mainly from urine specimens, and the composition ratio was 53.64%(839/1564). The use of main antibacterial drugs in this hospital has been increasing since 2015. Since 2013, the sensitivity of E coli to meropenem, piperacillin/tazobactam has decreased(P<0.001), and the sensitivity of E coli to piperacillin/tazobactam and levofloxacin was negatively correlated to its usage amount, and the difference was significant(P<0.05). CONCLUSION The drug resistance of E coli is not optimistic. The unreasonable use or abuse of antibiotics may further aggravate the emergence of drug resistance. It is recommended to select with caution when using antibiotics in clinic.
引文
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[30] 张永梅,高建钢,张志敏,等.内蒙地区老年人泌尿系感染耐药菌分布及耐药分析[J].内蒙古医科大学学报,2013,35(5):350-353.
[31] Tangden T,Adler M,Cars O,et al.Frequent emergence of porin-deficient subpopulations with reduced carbapenem susceptibility in ESBL-producing Escherichia coli during exposure to ertapenem in an in vitro pharmacokinetic model[J].J Antimicrob Chemother,2013,68(6):1319-1326.
[32] Livermore DM.Current epidemiology and growing resistance of gram-negative pathogens[J].The Korean J Intern Med,2012,27(2):128-142.
[33] 世界卫生组织.世卫组织发布迫切需要新型抗生素的细菌清单[EB/OL].http://www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/zh/,2017-2-27/2019-3-20.
[2] Biswas T,Das M,Mondal R,et al.Prevalence of ESBL-producing Escherichia coli and Klebsiella species with their co-resistance pattern to antimicrobials[J].Mymensingh Med J,2013,22(2):377-384.
[3] Davies J,Johnson AP,Hope R.Identifying hospital-onset Escherichia coli bacteraemia cases from English mandatory surveillance:the case for applying a two-day post-admission rule[J].J Hosp Infect,2017,97(3):207-211.
[4] Abernethy J,Guy R,Sheridan EA,et al.E.coli bacteraemia sentinel surveillance group.epidemiology of Escherichia coli bacteraemia in England:results of an enhanced sentinel surveillance programme[J].J Hosp Infect,2017,95(4):365-375.
[5] 张鹏亮,周磊,周珊,等.某院10年尿路感染大肠埃希菌耐药分析[J].检验医学与临床,2019,16(6):739-741.
[6] Ikeda Y,Mamiya T,Nishiyama H,et al.Risk factors for extended -spectrum beta- lactamase - producing Escherichia coli infection in hospitalized patients[J].Nagoya J Med Sci,2012,74(12):105-114.
[7] 郑小清,周秋仁,黄文权,等.2010-2014年我院大肠埃希菌耐药率与抗菌药使用量的相关性分析[J].广东医学院学报,2015,33(4):479-482.
[8] 危华玲,农生洲.我院大肠埃希菌耐药率与抗菌药使用量的相关性研究[J].中国药师,2014,17(5):822-824.
[9] Hsu LY,Tan TY,Tam VH,et al.Surveillance and correlation of antibiotic prescription and resistance of gram-negative bacteria in Singaporean hospitals[J].Antimicrob Agents Chemother,2010,54(3):1173-1178.
[10] 赵静,马艳丽,宁美英,等.我院2012-2014年抗菌药物用量与大肠埃希菌耐药率的相关性分析[J].中国药房,2016,27(5):608-612.
[11] 尚红,王毓三,申子瑜.全国临床检验操作规程(第4版)[M].北京,人民卫生出版社,2014:578-625.
[12] Clinical Laboratory Standard Institute.Performance standards for antimicrobial susceptibility testing[S].2016:M100S.
[13] 菅记涌,解泽强,全秀秀,等.血流感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2017,27(3):535-538.
[14] 刘彩欣,孙聚有,刘鹏,等.2014-2016年安徽某三甲医院大肠埃希菌分布及耐药性分析[J].长治医学院学报,2018,6:455-457.
[15] 李海英,王金波,王华,等.近3年分离大肠埃希菌耐药性的分析[J].中国抗生素杂志,2018,43(5):620-623.
[16] 袁星,胥振国,曹雷.泌尿系感染病原菌的分布及大肠埃希菌的耐药性分析[J].华北理工大学学报(医学版),2019,21(1):27-31.
[17] Nakai H,Hagihara M,Kato H,et al.Prevalence and risk factors of infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae[J].J Infect Chemother,2016,22(5):319-326.
[18] Alpay Y,Aykin N,Korkmaz P,et al.Urinary tract infections in the geriatric patients[J].Pak J Med Sci,2018,34(1):67-72.
[19] Lee DS,Choe HS,Lee SJ,et al.Antimicrobial susceptibility pattern and epidemiology of female urinary tract infections in South Korea,2010-2011[J].Antimicrob Agents Chemother,2013,57(11):5384-5393.
[20] 汪复,朱德妹,胡付品,等.2012中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2013,12(5):365-374.
[21] 胡付品,郭燕,朱德妹,等.2016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.
[22] Vojtova V,Kolar M,Hricova K,et al.Antibiotic utilization and Pseudomonas aeruginosa resistance in intensive care units[J].New Microbiol,2011,34(3):291-298.
[23] Thom KA,Maragakis LL,Richards K,et al.Assessing the burden of Acinetobacter baumannii in Maryland:a statewide cross-sectional period prevalence survey.[J].Infect Control Hosp Epidemiol,2012,33(9):883-888.
[24] 陈震,孙丽,吕雄文.某三甲医院抗菌药物使用情况与大肠埃希菌耐药相关性分析[J].安徽医药,2015,19(4):785-788.
[25] 展冠军,朱国龙,戴真南,等.临床不同标本及不同科室的大肠埃希菌耐药性分析[J].中国抗生素杂志,2018,43(6):734-738.
[26] CLSI.M100-S24.Performance standards for antimicrobial susceptibility testing;Twenty-second informational supplement[S].Wayne,PA,USA:CLSI,2014.
[27] Boyer A,Couallier V,Clouzeau B,et al.Control of extended-spectrum β-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit:A time series regression analysis[J].Am J Infect Control,2015,43(12):1296-1301.
[28] Hsu LY,Apisarnthanarak A,KhanE,et al.Carbapenem-re-sistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia[J].Clin Microbiol Rev,2017,30(1):1-22.
[29] Satlin MJ,Chen L,Patel G,et al.Bacteremia due to carbapenem-resistant Enterobacteriaceae(CRE):a multicenter clinical and molecular epidemiologic analysis in the Nation's Epicenter for CRE[J].Antimicrob Agents Chemother,2017,61(4):e02349-16.
[30] 张永梅,高建钢,张志敏,等.内蒙地区老年人泌尿系感染耐药菌分布及耐药分析[J].内蒙古医科大学学报,2013,35(5):350-353.
[31] Tangden T,Adler M,Cars O,et al.Frequent emergence of porin-deficient subpopulations with reduced carbapenem susceptibility in ESBL-producing Escherichia coli during exposure to ertapenem in an in vitro pharmacokinetic model[J].J Antimicrob Chemother,2013,68(6):1319-1326.
[32] Livermore DM.Current epidemiology and growing resistance of gram-negative pathogens[J].The Korean J Intern Med,2012,27(2):128-142.
[33] 世界卫生组织.世卫组织发布迫切需要新型抗生素的细菌清单[EB/OL].http://www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/zh/,2017-2-27/2019-3-20.