2403例妇产科术后感染患者多重耐药菌监测与耐药性分析
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摘要
目的:了解大连市妇幼保健院(以下简称"我院")妇产科术后感染患者多重耐药菌的监测结果及耐药情况,为临床合理选择抗菌药物提供参考。方法:收集2016年7月至2018年6月我院妇科和产科术后感染患者中分离的多重耐药菌,回顾性分析多重耐药菌的种类、分布及耐药性。结果:2016年7月至2018年6月我院妇科和产科发生术后感染的患者共2 403例,共分离出多重耐药菌208株,其中,革兰阴性菌175株(占84.13%),以大肠埃希菌为主;革兰阳性菌33株(占15.87%),以金黄色葡萄球菌为主。大肠埃希菌对氨苄西林酮的耐药率达100%;对阿米卡星、头孢替坦、美罗培南、亚胺培南和哌拉西林他唑巴坦敏感,耐药率均<10%。金黄色葡萄球菌对苄青霉素、红霉素和苯唑西林的耐药率>80%;对替加环素、万古霉素和利奈唑胺的敏感性为100%,尚未发现对万古霉素耐药的菌株。结论:多重耐药大肠埃希菌是我院妇产科患者术后感染最常见的多重耐药菌,对于可能为多重耐药菌感染的患者,经验治疗应首选大肠埃希菌对其耐药率低的抗菌药物。
OBJECTIVE: To investigate the monitoring results and drug resistance of multidrug-resistant bacteria in postoperative patients with obstetrics and gynecology in Maternal and Child Health Hospital of Dalian(hereinafter referred to as "our hospital"), so as to provide reference for clinical rational selection of antibiotics. METHODS: From Jul. 2016 to Jun. 2018, the multidrug-resistant bacteria isolated from patients with postoperative infection in gynecology and obstetrics department of our hospital were collected, and the species, distribution and drug resistance of multidrug-resistant bacteria were retrospectively analyzed. RESULTS: From Jul. 2016 to Jun. 2018, there were 2 403 patients with postoperative infections in gynecology and obstetrics department of our hospital. A total of 208 multidrug-resistant bacteria strains were isolated, of which 175 were Gram-negative bacteria(84.13%), and Escherichia coli was the main one; 33 strains of gram-positive bacteria(15.87%) were mainly Staphylococcus aureus. The drug resistance rate of Escherichia coli to Ampicillin reached 100%. Escherichia coli was sensitive to amikacin, cefotetan, meropenem, imipenem and piperacillin, and the drug resistance rate was < 10%. The drug resistance rate of Staphylococcus aureus to benzylpenicillin, erythromycin and benzocillin was > 80%, the sensitivity to tegacycline, vancomycin and linezolid was 100%, and no vancomycin resistant strains had been identified. CONCLUSIONS: Escherichia coli is the most common multidrug-resistant strain in postoperative infections in obstetrics and gynecology patients in our hospital. Antibacterial agents with low drug resistance rate of Escherichia coli should be the first choice for the treatment of patients who may have multidrug-resistant bacterial infections.
OBJECTIVE: To investigate the monitoring results and drug resistance of multidrug-resistant bacteria in postoperative patients with obstetrics and gynecology in Maternal and Child Health Hospital of Dalian(hereinafter referred to as "our hospital"), so as to provide reference for clinical rational selection of antibiotics. METHODS: From Jul. 2016 to Jun. 2018, the multidrug-resistant bacteria isolated from patients with postoperative infection in gynecology and obstetrics department of our hospital were collected, and the species, distribution and drug resistance of multidrug-resistant bacteria were retrospectively analyzed. RESULTS: From Jul. 2016 to Jun. 2018, there were 2 403 patients with postoperative infections in gynecology and obstetrics department of our hospital. A total of 208 multidrug-resistant bacteria strains were isolated, of which 175 were Gram-negative bacteria(84.13%), and Escherichia coli was the main one; 33 strains of gram-positive bacteria(15.87%) were mainly Staphylococcus aureus. The drug resistance rate of Escherichia coli to Ampicillin reached 100%. Escherichia coli was sensitive to amikacin, cefotetan, meropenem, imipenem and piperacillin, and the drug resistance rate was < 10%. The drug resistance rate of Staphylococcus aureus to benzylpenicillin, erythromycin and benzocillin was > 80%, the sensitivity to tegacycline, vancomycin and linezolid was 100%, and no vancomycin resistant strains had been identified. CONCLUSIONS: Escherichia coli is the most common multidrug-resistant strain in postoperative infections in obstetrics and gynecology patients in our hospital. Antibacterial agents with low drug resistance rate of Escherichia coli should be the first choice for the treatment of patients who may have multidrug-resistant bacterial infections.
引文
[1] 陈伟梅,范先伟.妇产科多重耐药菌感染的高危因素分析及临床对策[J].中国现代医药杂志,2012,14(8):49-50
[2] 黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防和控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.
[3] 杨旭,何薇,王清,等.某三甲综合医院多重耐药菌分布及耐药性分析[J].国际检验医学杂志,2015,36(20):2958-2960.
[4] 汤丽霞,韦中盛,龙显科,等.多重耐药菌医院感染监测及耐药性分析[J].中国老年学杂志,2014,34(40):3539-3541.
[5] 郑海波,何平,王月玲,等.山东某院2012—2016年主要多重耐药菌分布特点[J].国际检验医学杂志,2018,39(4):419-421,425.
[6] 修连喜,赖善城,林素珍.907株多重耐药菌的分布及临床药师对其药物治疗的干预[J].中国医院用药评价与分析,2018,18(2):270-273.
[7] 李甲.某三级甲等医院多重耐药菌感染现状研究[D].济南:山东大学,2015.
[8] 王卓,王雨新,陈强,等.产ESBLs肠杆菌科细菌的检测及耐药性[J].中国微生态学杂志,2016,28(5):564-566,569.
[9] 贺秀梅,宋香清,阎敏.本院氨曲南对常见革兰阴性菌的耐药趋势及其不合理用药的分析与评价[J].中南药学,2014,12(7):716-720.
[10] 国家卫生计生委办公室,国家中医药管理局办公室,总后卫生部药品器材局.关于印发《抗菌药物临床应用指导原则(2015年版)》的通知[S].国卫办医发[2015]43号.2015-07-24.
[11] 凌玲,吴伟旋,孙树梅,等.多重耐药菌医院感染直接经济负担的系统评价[J].中国感染控制杂志,2017,16(7):616-621.
[12] 王凤英,吴香竹,张菁云.妇产科患者术后感染的临床分析[J].中华医院感染学杂志,2015,25(6):1396-1397,1400.
[13] 孙晓红,汪红.426例住院患者多重耐药菌感染影响因素分析及其对策[J].抗感染药学,2017,14(7):1312-1314.
[14] 茅国峰,徐儿.哌拉西林/他唑巴坦与头孢哌酮/舒巴坦治疗细菌性感染疗效的Meta分析[J].中华实验和临床感染病杂志:电子版,2016,10(3):269-273.
[15] 唐可京,罗益锋,苏霞,等.头孢哌酮/舒巴坦与亚胺培南/西司他丁和哌拉西林/他唑巴坦治疗革兰阴性菌感染的药物经济学评价[J].中华医院感染学杂志,2017,27(15):3385-3391.
[2] 黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防和控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.
[3] 杨旭,何薇,王清,等.某三甲综合医院多重耐药菌分布及耐药性分析[J].国际检验医学杂志,2015,36(20):2958-2960.
[4] 汤丽霞,韦中盛,龙显科,等.多重耐药菌医院感染监测及耐药性分析[J].中国老年学杂志,2014,34(40):3539-3541.
[5] 郑海波,何平,王月玲,等.山东某院2012—2016年主要多重耐药菌分布特点[J].国际检验医学杂志,2018,39(4):419-421,425.
[6] 修连喜,赖善城,林素珍.907株多重耐药菌的分布及临床药师对其药物治疗的干预[J].中国医院用药评价与分析,2018,18(2):270-273.
[7] 李甲.某三级甲等医院多重耐药菌感染现状研究[D].济南:山东大学,2015.
[8] 王卓,王雨新,陈强,等.产ESBLs肠杆菌科细菌的检测及耐药性[J].中国微生态学杂志,2016,28(5):564-566,569.
[9] 贺秀梅,宋香清,阎敏.本院氨曲南对常见革兰阴性菌的耐药趋势及其不合理用药的分析与评价[J].中南药学,2014,12(7):716-720.
[10] 国家卫生计生委办公室,国家中医药管理局办公室,总后卫生部药品器材局.关于印发《抗菌药物临床应用指导原则(2015年版)》的通知[S].国卫办医发[2015]43号.2015-07-24.
[11] 凌玲,吴伟旋,孙树梅,等.多重耐药菌医院感染直接经济负担的系统评价[J].中国感染控制杂志,2017,16(7):616-621.
[12] 王凤英,吴香竹,张菁云.妇产科患者术后感染的临床分析[J].中华医院感染学杂志,2015,25(6):1396-1397,1400.
[13] 孙晓红,汪红.426例住院患者多重耐药菌感染影响因素分析及其对策[J].抗感染药学,2017,14(7):1312-1314.
[14] 茅国峰,徐儿.哌拉西林/他唑巴坦与头孢哌酮/舒巴坦治疗细菌性感染疗效的Meta分析[J].中华实验和临床感染病杂志:电子版,2016,10(3):269-273.
[15] 唐可京,罗益锋,苏霞,等.头孢哌酮/舒巴坦与亚胺培南/西司他丁和哌拉西林/他唑巴坦治疗革兰阴性菌感染的药物经济学评价[J].中华医院感染学杂志,2017,27(15):3385-3391.
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