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目的:研究天津市血流感染细菌耐药分布及耐药性。方法:收集2014年度天津市45家医院血标本来源细菌药敏结果,用CLSI 2014年标准判读,WHONET5.6进行药物敏感性分析。结果:分离共计4 772株细菌,其中革兰阳性菌2 038株,占42.7%,革兰阴性菌2 734株,占57.3%,葡萄球菌属1 409株,占29.5%,肠球菌属335株占7.0%,肠杆菌科细菌2 248株,占47.1%,非发酵菌438株,占9.2%,肺炎链球菌35株,占0.7%。最常见细菌依次为大肠埃希菌(27.3%)、凝固酶阴性葡萄球菌(23.8%)、肺炎克雷伯菌(12.1%)、金黄色葡萄球菌(5.6%)、铜绿假单胞菌(4.1%)。耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和耐甲氧西林金黄色葡萄球菌(MRSA)的检出率分别为78.5%和25.3%。MRSA和MRCNS的耐药率明显高于甲氧西林敏感金黄色葡萄球菌(MSSA)和甲氧西林敏感凝固酶阴性葡萄球菌(MSCNS)。未发现对万古霉素耐药的葡萄球菌。粪肠球菌和屎肠球菌对万古霉素敏感率分别为100%和98.1%,共检出耐万古霉素的屎肠球菌(VRE)3株。大肠埃希菌对亚胺培南的敏感率为98.7%,肺炎克雷伯菌对亚胺培南的敏感率为95.3%。大肠埃希菌和肺炎克雷伯菌中产ESBLs株分别占60.1%和33.3%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为21.6%和17.5%。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为39.6%和49.3%。结论:本年度所分离血培养细菌的耐药较为普遍,加强耐药性监测,指导临床合理使用抗菌药物十分重要。
Objective: To study the drug resistance distribution and drug resistance of blood-borne bacteria in Tianjin. Methods: The bacterial susceptibility results of blood samples collected from 45 hospitals in Tianjin in 2014 were collected and interpreted according to the CLSI 2014 standard. WHONET 5.6 was used for drug sensitivity analysis. Results: A total of 4 772 bacteria were isolated, of which 2 038 were Gram-positive bacteria, accounting for 42.7%, 2 734 Gram-negative bacteria accounting for 57.3%, 1 409 Staphylococcus, accounting for 29.5%, 335 Enterococcus Accounting for 7.0%, Enterobacteriaceae 2 248 strains, accounting for 47.1%, non-ferment bacteria 438 strains, accounting for 9.2%, 35 strains of Streptococcus pneumoniae, accounting for 0.7%. The most common bacteria were Escherichia coli (27.3%), coagulase negative Staphylococcus (23.8%), Klebsiella pneumoniae (12.1%), Staphylococcus aureus (5.6%), Pseudomonas aeruginosa %). The detection rates of MRCNS and methicillin-resistant Staphylococcus aureus (MRSA) were 78.5% and 25.3%, respectively. The resistance rates of MRSA and MRCNS were significantly higher than those of methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-sensitive coagulase-negative Staphylococcus aureus (MSCNS). No vancomycin-resistant staphylococci were found. Enterococcus faecalis and Enterococcus faecium susceptibility to vancomycin were 100% and 98.1%, respectively, were detected vancomycin-resistant Enterococcus faecium (VRE) 3 strains. The susceptibility of Escherichia coli to imipenem was 98.7%, and the sensitivity of Klebsiella pneumoniae to imipenem was 95.3%. Escherichia coli and Klebsiella pneumoniae ESBLs producing strains accounted for 60.1% and 33.3%. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 21.6% and 17.5%, respectively. Acinetobacter baumannii resistance rates to imipenem and meropenem were 39.6% and 49.3%, respectively. Conclusion: The resistance of blood culture bacteria isolated in this year is more common. It is very important to strengthen the monitoring of drug resistance and guide the rational use of antibiotics in clinic.