2001-2004年细菌耐药性监测及分析

Surveillance of Bacterial Resistance at a Hospital in Western China

目的了解我院乃至包头地区常见病原菌耐药情况,探讨2001～2004年细菌耐药及4年间耐药菌的变迁,为临床合理使用抗菌药物提供依据. 方法收集4年间我院临床标本分离病原菌及其药敏资料,用WHONET5.1软件进行统计分析. 结果共收集病原菌2 127株,分离率居前9位者分别为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、表皮葡萄球菌、阴沟肠杆菌、肠球菌属、金黄色葡萄球菌、弗氏柠檬酸杆菌,其中革兰阳性球菌 497株,占23.4%,革兰阴性杆菌1 630株,占76.6%;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林表皮葡萄球菌(MRSE)分别占68.2%和85.6%,未发现万古霉素耐药株;大肠埃希菌和克雷伯菌属产超广谱β-内酰胺酶(ESBLs)的发生率分别为24.4%和22.7%;鲍氏不动杆菌对第三代头孢菌素和亚胺培南的耐药率分别接近50%和16%,而喹诺酮类敏感率则＞70%;铜绿假单胞菌对头孢他啶和亚胺培南的耐药率达21.3%和13.4%. 结论本院常见病原菌耐药严重,临床应重视细菌学检查和耐药性资料的获得,合理使用抗菌药物,遏制抗菌药物的滥用.

OBJECTIVE To investigate the bacterial resistance of clinical isolates obtained from our hospital and to determine the changes of drug-resistant bacteria during the years of 2001 to 2004 for the guidance of rational use of antibiotics. METHODS Antimicrobial susceptibility of clinical isolates from our hospital was tested by Kirby-Bauer plate dilution method and the collected resistance data were analyzed with the software of WHONET 5.1. RESULTS Of 2 127 clinical isolates, the isolates of Gram positives and negatives were 497 and 1 630, accounted for 23.4% and 76. 6%, respectively, The top nine isolates were Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae , Acinetobacter, Staphylococcus epidermidis , Enterobacter cloacae, Enterococcus, S. aureus and Citrobacter. MRSA and MRSE accounted for 68.2% and 85.6% in S. aureus and S. epidermidis. No vancomycin resistant strains were found. The ESBLs producing strains accounted for 24.4 % and 22.7 % in E. coli and K. pneumoniae, respectively. The resistance rate of Acinetobacter baumannii to the third generation cephalosporins, imipenem and the quinolones was about 50%, 16% and less than 30%, respectively. The resistance rate of P. aeruginosa to ceftazidime and imipenem was 21.3% and 13.4%. CONCLUSIONS The resistance of commonly encoutered bacteria to antimicrobial agents in this hospital is a serious problem and bacteriological tests and resistance data should be emphasized for the purpose of rational use of antimicrobial agents and the containment of antibiotic abuse.