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目的:分析山东省立医院2012~2016年临床分离细菌的分布及对常用抗菌药物的耐药性变迁。方法:除葡萄球菌属采用VITEK 2 Compact测定其药物敏感性外,其余菌株均采用纸片扩散法。参照CLSI 2016版折点判读结果,使用WHONET5.6软件统计分析。结果:2012~2016年共收集非重复临床分离菌21 568株,其中革兰阴性菌占69.58%,革兰阳性菌占30.42%。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类和阿米卡星抗菌药物敏感性最高,在90%以上;共检出碳青霉烯类抗菌药物耐药的肠杆菌科(CRE)393株。铜绿假单胞菌敏感率最高的药物是阿米卡星(87.8%)和哌拉西林/他唑巴坦(86.8%);鲍曼不动杆菌除对头孢哌酮/舒巴坦(耐药率27.2%)和米诺环素(34.9%)敏感外,其余抗菌药物的耐药率均在40%以上。甲氧西林耐药金色葡萄球菌(MRSA)的平均检出率为30.8%。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。屎肠球菌对多数药物的耐药率高于粪肠球菌,5年间共检出9株万古霉素耐药的肠球菌(VRE)。肺炎链球菌对红霉素和克林霉素的耐药率均在96%以上,非脑膜炎菌株中检出青霉素耐药株(PRSP)14株,占1.30%,脑膜炎菌株中检出PRSP 5株,占35.71%。流感嗜血杆菌β内酰胺酶阳性率为56.00%。结论:该院5年监测数据显示,细菌的耐药性呈增高趋势,尤其是多重耐药菌的分离率亦升高明显,应重视细菌耐药性监测并应采取有效的医院感染控制措施和加强抗菌药物的合理使用。
Objective: To analyze the distribution of clinically isolated bacteria in Shandong Provincial Hospital from 2012 to 2016 and the change of drug resistance to commonly used antibiotics. Methods: In addition to Staphylococcus using VITEK 2 Compact determination of drug sensitivity, the other strains were used disk diffusion method. Refer to CLSI 2016 version breakpoint interpretation results, using WHONET5.6 software statistical analysis. Results: A total of 21 568 non-repetitive clinical isolates were collected from 2012 to 2016, of which Gram-negative bacteria accounted for 69.58% and Gram-positive bacteria accounted for 30.42%. Escherichia coli and Klebsiella pneumoniae were the most susceptible to carbapenems and amikacin antibiotics, more than 90%; a total of carbapenem-resistant strains of Enterobacteriaceae (CRE ) 393 strains. Pseudomonas aeruginosa the most sensitive drugs are amikacin (87.8%) and piperacillin / tazobactam (86.8%); Acinetobacter baumannii cefoperazone / sulbactam (resistant Rate of 27.2%) and minocycline (34.9%) sensitive, the remaining antibiotic resistance rates were above 40%. The average detection rate of methicillin-resistant Staphylococcus aureus (MRSA) was 30.8%. No staphylococci resistant to vancomycin, teicoplanin and linezolid were found. Enterococcus faecium resistant to most drugs than Enterococcus faecalis, 5 years, a total of 9 were detected vancomycin-resistant Enterococcus (VRE). Streptococcus pneumoniae erythromycin and clindamycin resistance rates were above 96%, non-meningitis strains detected penicillin-resistant strains (PRSP) 14 strains, accounting for 1.30%, detected in the meningitis strains PRSP 5 strains, accounting for 35.71%. Haemophilus influenzae beta lactamase positive rate of 56.00%. CONCLUSION: The 5-year surveillance data of this hospital show that the drug resistance of bacteria is on the rise. Especially the isolation rate of multi-drug-resistant bacteria also increases obviously. The surveillance of bacterial drug resistance should be emphasized and effective nosocomial infection control measures should be taken and Strengthen the rational use of antibacterial drugs.