2013年临床分离菌耐药性分析

目的了解南昌大学第二附属医院2013年临床分离菌对抗菌药物的耐药性。方法采用纸片扩散法或自动化仪器法进行药敏试验,参照CLSI 2013年版判读结果,用WHONET5.5软件进行数据分析。结果2013年共收集非重复临床分离菌3996株,其中革兰阴性菌2 623株（65.6%）,革兰阳性菌1 373株（34.4%）。标本来源以痰液为主（23.2%）,其次为血液（21.6%）和尿液（17.8%）。居前5位的菌种依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌和鲍曼不动杆菌,分别占20.9%、10.1%、9.4%、8.7%和7.4%。甲氧西林耐药金葡菌和CNS（MRSA和MRCNS）分别占各自菌株的21.3%和82.0%,未发现对万古霉素和替加环素耐药的葡萄球菌。肺炎链球菌中青霉素耐药株占16.4%,β溶血性链球菌对红霉素、克林霉素和四环素耐药率较高。屎肠球菌对多数抗菌药物的耐药率高于粪肠球菌,共检测出2株粪肠球菌对万古霉素耐药。大肠埃希菌和克雷伯菌属细菌（肺炎克雷伯菌、产酸克雷伯菌）中ESBLs的检出率分别为60.2%和27.2%,产ESBLs株对大多数抗菌药物的耐药率高于非产ESBLs株。肠杆菌科细菌对厄他培南和亚胺培南的耐药率均低于10%。铜绿假单胞菌对亚胺培南的耐药率为8.7%。鲍曼不动杆菌除对左氧氟沙星耐药率为34.6%外,对其他常用抗菌药物的耐药率均大于50.0%,多重耐药鲍曼不动杆菌的检出率为74.9%。结论我院临床分离菌仍以革兰阴性杆菌为主,细菌耐药性仍是临床重要问题,尤其是耐碳青霉烯类抗生素肺炎克雷伯菌（CRKP）增加较快,应引起临床高度重视。

Analysis of bacterial resistance during 2013

Objective To investigate the distribution and antimicrobial resistance of clinical bacterial isolates in the Second Affiliated Hospital of Nanchang University. Methods Antimicrobial susceptibility testing was carried out using Kirby-Bauer method or automated systems. Results were determined according to the breakpoints of CLSI2013. All data were analyzed by WHONET5. 5 software. Results A total of 3,996 nonduplicate clinical isolates were collected during 2013,including gram negative bacteria（ 2623,65. 6%） and gram positive bacteria（ 1373,34. 4%）. The main sources of the specimens were sputum（ 23. 2%）,followed by blood（ 21. 6%） and urine（ 17.8%）. The top five bacterial species were Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus,Pseudomonas aeruginosa and Acinetobacter baumannii,accounting for 20. 9%,10. 1%,9. 4%,8. 7% and 7. 4%,respectively. The prevalence of MRSA in S. aureus and MRCNS in Coagulase-negative Staphylococcus was 21. 3%and 82. 0%,respectively. No staphylococcal strain was found resistant to vancomycin and tigecycline. The prevalence of PRSP was 16. 4%. The resistance rates of beta-hemolytic Streptococcus to eythromycin,cindamycin and tetracycline were higher. The resistance rates of E. faecium strains to most tested drugs were much higher than those of E. faecalis. Vancomycin resistance was found in 2 E. faecalis strains. The prevalence of ESBLs was60. 2% in E. coli and 27. 2% in Klebsiella spp.（ K. pneumoniae and K. oxytoca）. ESBLs-producing strains were more resistant to most antibiotics than non-ESBLs-producing strains. Enterobacteriaceae strains were very sensitive to carbapenems,and the percentages of Enterobacteriaceae strains resistant to ertapenem and imipenem were less than 10%. Imipenem resistance was found in 8. 7% of P. aeruginosa isolates. More than 50. 0% of the A. baumannii strains were resistant to all the drug tested except levofloxacin,to which only 34. 6% were resistant. The detection rate of multi-drug resistant A. baumannii was 74. 9%. Conclu