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目的通过分析临床分离菌种分布及耐药性,指导临床合理应用抗菌药物。方法收集天津市第三中心医院2011年1月-2015年12月36205株临床分离菌,采用纸片扩散法或自动化仪器法按统一方案进行细菌药物敏感性试验,根据CLSI(2008年版)标准判断结果。结果革兰阳性菌与革兰阴性菌分别占24.97%、75.03%。耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)对多数所测试抗菌药物敏感率显著低于对甲氧苯青霉素敏感金黄色葡萄球菌(MSSA)、对甲氧苯青霉素敏感凝固酶阴性葡萄球菌(MSCNS),对青霉素、氨苄青霉素、苯唑青霉素和头孢唑林全部耐药,对万古霉素、替考拉宁、利奈唑烷全部敏感。肠球菌属中屎肠球菌对多数所测试抗菌药物的敏感率显著低于粪肠球菌,且出现少数万古霉素耐药株。MRSA、MRCNS检出率总体呈下降趋势。大肠埃希菌、克雷伯菌和奇异变形杆菌中产超广谱β内酰胺酶(ESBL)菌株对所测试抗菌药物的敏感率显著低于非产ESBL菌株。肠杆菌属对碳青霉烯类抗生素仍保持较高敏感性(85%~100%)。大肠埃希菌、克雷伯菌产ESBL菌株检出率总体呈上升趋势。结论细菌耐药性总体呈上升趋势。加强对细菌耐药的监测,结合药敏试验调整用药,对控制细菌耐药性及提高临床疗效具有更重要意义。
Objective To analyze the distribution of clinical isolates and drug resistance and guide the rational use of antibacterials in clinic. Methods 36205 clinical isolates were collected from the Third Central Hospital of Tianjin from January 2011 to December 2015. Bacterial drug susceptibility tests were carried out according to a unified protocol using disc diffusion or automated instrumentation. According to CLSI (2008 edition) standard result. Results Gram-positive bacteria and Gram-negative bacteria accounted for 24.97%, 75.03%. Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCNS) were significantly less susceptible to the majority of tested antibacterials than to methicillin-susceptible Staphylococcus aureus (MSSA) Methicillin-sensitive coagulase-negative staphylococci (MSCNS) are resistant to penicillin, ampicillin, oxacillin and cefazolin, and are all susceptible to vancomycin, teicoplanin and linezolid. Enterococcus faecium Enterococcus faecium susceptibility to most of the tested antibiotics was significantly lower than Enterococcus faecalis, and a small number of vancomycin-resistant strains. MRSA, MRCNS overall decline in the detection rate. Escherichia coli, Klebsiella and Proteus mirabilis ESBL strains were significantly less susceptible to the tested antimicrobials than non-ESBL-producing ESBL strains. Enterobacter carbapenem antibiotics remain highly sensitive (85% to 100%). The detection rate of Escherichia coli and Klebsiella producing ESBL strains is generally on the rise. Conclusions Bacterial drug resistance is generally on the rise. To strengthen the monitoring of bacterial resistance, combined with drug susceptibility testing to adjust medication, to control bacterial resistance and improve clinical efficacy is more important.