2019年北京协和医院细菌耐药性分析

刘文静; 徐英春; 杨启文; 王瑶; 孙宏莉; 赵颖; 窦红涛; 刘亚丽; 郭莉娜; 朱任媛; 张丽; 肖盟; 张小江

doi:10.3969/j.issn.1674-9081.2020.00.015

摘要:

目的了解2019年北京协和医院分离的常见细菌对抗菌药物的耐药性。

方法回顾性分析2019年1月1日至12月31日从北京协和医院分离的11 404株非重复细菌的药敏结果。

结果 11 404株细菌中革兰氏阴性菌占63.8%(7276/11 404)、革兰氏阳性菌占36.2%(4128/11 404)。葡萄球菌属中，甲氧西林耐药的金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)和甲氧西林耐药的凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococcus, MRCNS)的检出率分别为18.9%(191/1009)和77.3%(659/853)，两者对红霉素的耐药率均较高(79.6%、83.2%)。肠球菌属中，屎肠球菌和粪肠球菌的检出率别为38.2% (437/1143)和54.6%(624/1143)，对利奈唑胺(0.2%、0.3%)、万古霉素(4.3%、0.2%)和替考拉宁(3.0%、0)的耐药率较低。链球菌属中，肺炎链球菌、α溶血链球菌、A群和B群β溶血链球菌的检出率分别为12.8%(130/1012)、37.9%(384/1012)、4.2%(43/1012)和39.0%(395/1012)，各菌种对红霉素、阿奇霉素和克林霉素的耐药率较高，其中肺炎链球菌和A群β溶血链球菌对此3种抗菌药物的耐药率均≥88.7%。肠杆菌科中，碳青霉烯类耐药肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae, CRE)、肺炎克雷伯菌广泛耐药(extensive drug resistance, XDR)菌株的检出率分别为7.1%(308/4324)、4.7%(60/1273)；肠杆菌科细菌对替加环素、碳青霉烯类和阿米卡星的耐药率较低。不发酵糖革兰氏阴性杆菌中，鲍曼不动杆菌对替加环素的耐药率最低(6.9%)，对哌拉西林的耐药率最高(93.3%)；铜绿假单胞菌对阿米卡星的耐药率最低(4.5%)，对左氧氟沙星的的耐药率最高(22.6%)；鲍曼不动杆菌和铜绿假单胞菌中XDR菌株的检出率为12.3%(117/949)和1.8%(21/1137)。流感嗜血杆菌中，β-内酰胺酶的阳性率为34.1% (45/132)；流感嗜血杆菌对氨苄西林的耐药率最高(62.9%)，除氯霉素外对其他抗菌药物的耐药率为33.3%~48.4%。

结论 2019年北京协和医院分离的常见细菌对常用抗菌药物有不同程度的耐药，可能对抗菌药物的合理使用和科学管理有指导作用。

Abstract:

Objective To investigate the antimicrobial resistance of clinical bacterial isolates in Peking Union Medical College Hospital (PUMCH) in 2019.

Methods The antimicrobial resistance of 11 404 non-duplicated common bacteria isolated from PUMCH during January 1 to December 31, 2019 were retrospectively analyzed.

Results In the totally 11 404 clinical isolates, Gram-negative bacilli and gram-positive cocci accounted for 63.8% (7276/11 404) and 36.2% (4128/11 404), respectively. Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-resistant coagulase-negative Staphylococcus(MRCNS) accounted for 18.9%(191/1009) and 77.3% (659/853), respectively, both of which had a high resistance rate to erythromycin (79.6%, 83.2%). Enterococcus faecium and Enterococcus faecalis accounted for 38.2% (437/1143) and 54.6% (624/1143) in Enterococci, respectively; and the resistance rates to linezolid (0.2%, 0.3%), vancomycin (4.3%, 0.2%) and teicoplanin (3.0%, 0) were low. The detection rates of Streptococcus pneumoniae, α -hemolytic Streptococcus, group A and group B β -hemolytic Streptococcus were 12.8% (130/1012), 37.9%(384/1012), 4.2% (43/1012) and 39.0% (395/1012) in Streptococcus, respectively. The resistance rates of all strains to erythromycin, azithromycin and clindamycin were more than 88.7% in Streptococcus pneumoniae and group β -hemolytic Streptococcus. Among the Enterobacteriaceae, the detection rates of carbapenem resistant Enterobacteriaceae(CRE) and extensive drug resistance (XDR) strains in Klebsiella pneumoniae were 7.1%(308/4324) and 4.7% (60/1273), respectively. The resistance rates of Enterobacteriaceae to tigecycline, carbapenems and amikacin were low. Among the non-fermentative Gram negative bacilli, Acinetobacter baumannii had the lowest resistance rate to tigecycline (6.9%) and the highest resistance rate to piperacillin (93.3%); Pseudomonas aeruginosa had the lowest resistance rate to amikacin (4.5%) and the highest resistance rate to levofloxacin (22.6%). The detection rates of XDR strains in Acinetobacter baumannii and Pseudomonas aeruginosa were 12.3% (117/949) and 1.8%(21/1137), repectively. Among Haemophilus influenzae, the positive rate of β-lactamase was 34.1%(45/132); the resistance rate to ampicillin was the highest (62.9%); the resistance rate to other antibiotics except chloramphenicol were 33.3%-48.4%.

Conclusions The common bacteria isolated from PUMCH in 2019 have different degrees of resistance to commonly used antibiotics, which may play a guiding role in the rational use and scientific management of antibiotics.

2019年北京协和医院细菌耐药性分析

Analysis of Antimicrobial Resistance in Peking Union Medical College Hospital in 2019