摘要
目的了解临床分离的常见病原菌耐药性及其变迁,以指导临床用药。方法回顾性分析1998年1月-2011年12月临床所有分离株的分布及其耐药性,对13年的数据分1998-2002、2003-2005、2006-2008、2009-2011年4个阶段,所有数据用WHONET5.4软件分析处理,用χ2检验其耐药性变迁差异性。结果 15 049株细菌中革兰阳性菌4 527株占30.1%,革兰阴性菌10 522株占69.9%;MRSA和MRCNS的检出率分别为29.3%和72.7%;MRSA和MRCNS对β-内酰胺类、大环内酯类、氨基糖苷类和喹诺酮类等抗菌药物的耐药率,〉70.0%;发现少量耐替考拉宁的MRCNS;大肠埃希菌、肺炎克雷伯菌中产ESBLs的检出率39.1%～51.8%和33.5%～37.9%,对头孢三、四代抗菌药物耐药率上升最快,发现了肺炎克雷伯菌对碳青霉烯类耐药菌株;铜绿假单胞菌对亚胺培南的耐药率达到21.6%;不动杆菌属对多种抗菌药物耐药率增加明显,其中对亚胺培南的耐药率达到71.9%。结论细菌耐药性呈增长趋势,出现少数耐替考拉宁的MRCNS和泛耐药肺炎克雷伯菌以及泛耐药鲍氏不动杆菌,加强抗菌药物的宏观管理,正确选择和使用抗菌药物,推迟或延缓细菌耐药性的发生。
OBJECTIVE To understand the drug resistance of clinical isolates of common pathogenic bacteria and an- alyze its change so as to guide clinical medication. METHODS From Jan 1998 to Dec 2011, the distribution and drug resistance of all the clinical isolates were retrospectively analyzed, then the data collected in the thirteen years were divided into four phases as follows： phase 1998-- 2002, phase 2003-2005, phase 2006-2008, and phase 2009-2011; all the data were analyzed by using WHONETS. 4 software, and the difference in the change of drug resistance was observed with the use of chi-square test. RESULTS Of 15 049 strains of bacteria, 4 527 strains were gram-positive bacteria, accounting for 30. 1%, and 10 522 strains were gram-negative bacteria, accounting for 69.9%. The isolation rates of MRSA and MRCNS were 29.3% and 72.7%, respectively. The drug resistance rates of MRSA and MRCNS to β-lactams, macrolides, aminoglycosides, and quinolones were more than 70.0% ; a few strains of teicoplanin-resistance MRCNS have been found. The isolation rate of ESBLs-producing Escherichia coli varied from 39.1% to 51.8 %, the isolation rate of ESBLs-producing Klebsiella pneumoniae varied from 33.5 to 37.9%%, and the drug resistance rates to the third and fourth generations of cephalosporins increased most rapid- ly. The carbapenem-resistant K. pneumoniae strains have been detected. The drug resistance rate of Pseudomonas aeruginosa to imipenem was up to 21.6 %. The drug resistance rates of Acinetobacter baumannii to multiple anti- biotics were increased significantly, and the drug resistance rate to imipenem reached 71.9%. CONCLUSION The bacterial drug resistance shows an upward trend, a few strains of teicoplanin-resistant MRCNS, pandrug-resistant K. pneumoniae, and pandrug-resistant A. baumannii have emerged. It is necessary to strengthen the macro man- agement of antibiotics and reasonably use antibiotics so as to postpone the emergence of drug resistance.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第13期3158-3160,共3页
Chinese Journal of Nosocomiology
基金
安徽省卫生厅自然科学基金项目(2002A012)
安徽省临床医学应用技术基金资助项目(2008A058)
关键词
细菌
耐药性
抗菌药物
药敏试验
变迁
Bacteria
Drug resistance
Antibiotic
Drug susceptibility testingl Change
