1385株临床流行菌株调查及耐药分析

Investigation of the clinical popular strain and drug-resistance in 1385 cases

目的分析我院2005年至2009年近5年间临床流行菌株及耐药谱的变化,为指导临床控制院内感染和合理使用抗菌药物提供参考。方法用Excel软件从LIS数据库中采集同期本院住院患者送检标本中分离的所有菌株共1385株。菌株鉴定和药敏试验采用ATB Expression细菌鉴定系统和药敏板条,并进行统计分析。结果近5年间院内感染以金黄色葡萄球菌和铜绿假单胞菌为主,而鲍氏不动杆菌检出率呈逐年递增趋势。在创面分泌物、血液和静脉留置针中,以金黄色葡萄球菌占优势,而尿液和痰标本则分别以大肠埃希菌和铜绿假单胞菌为主。不同标本分离的铜绿假单胞菌对同种抗菌药物敏感性差异显著,痰标本分离株对美洛培南、亚胺培南、替卡西林、哌拉西林、替卡西林/克拉维酸、哌拉西林/他唑巴坦、头孢他啶的耐药率远高于创面分泌物标本。结论引起院内感染的主要菌株为革兰阳性金黄色葡萄球菌和革兰阴性铜绿假单胞菌。痰标本分离的铜绿假单胞菌株对碳青霉烯类、抗假单胞菌类、β-内酰胺酶复合抑制剂类和Ⅲ代头孢的耐药率高于创面分泌物分离株。

Objective To impart reference on directing clinical control nosocomial infection and reasonably using antibiotics,the alteration on clinical popular strain and drug resistance spectrum between 2005 and 2009 were analyzed.Methods Using self-made Excel software,1385 cases were collected from laboratory information system(LIS) and all the strain isolated from the same period the inpatients specimens.Bacterium identification and antimicrobial susceptibility test were performed using ATB Expression system,and analysis of different specimens and years popular strain and drug resistance spectrum were performed using Excel perspective chart.Results In recent five years,Staphylococcus aureus and pseudomonas aeruginosa were the predominant pathogen of nosocomial infection,but Acinetobacter baumanii has been increasing trend.In secretion,blood and indwelling needles the predominant pathogen were staphylococcus aureus,and escherichia coli and pseudomonas aeruginosa in urine and sputum,respectively.The susceptibility of pseudomonas aeruginosa from different specimens to same antimicrobial was significantly different.The drug-resistance of Pseudomonas aeruginosa separated from sputum on meropenem,imipenem,ticarcillin,piperacillin,ticarcillin-clavulani cacid,piperacillin-tazobactam,ceftazidime were higher than that separated from secretion.Conclusion Staphylococcus aureus and Pseudomonas aeruginosa were the predominant pathogen of nosocomial infection.The drug-resistance of Pseudomonas aeruginosa separated from sputum on carbapenems,anti-pseudomonas,β-lactamase compound and Ⅲcephalosporin were higher than that separated from secretion.