2003年湘雅医院临床分离菌的分布及耐药性分析

Distribution and Resistance of Clinical Isolates in Xiangya Hospital in 2003

目的 了解湘雅医院临床分离病原菌的分布及耐药性，为临床合理应用抗菌药物提供依据。方法 应用MicroSean微生物分析系统，结合K-B法药敏试验对临床分离菌株进行鉴定和药物敏感性测定，以SPSS软件对结果进行统计分析。结果 3747株病原菌中，革兰阴性（G^-）杆菌2052株，占54，8％；革兰阳性（G^-）球菌1629株，占43.5％。在G^-杆菌中分离率居前五位的依次为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和阴沟肠杆菌；G杆菌对美洛培南的耐药率最低，在0％～6．4％之间；其次为头孢哌酮／舒巴坦。G^-杆菌对其他常用抗菌药物的耐药率为4.4％-85．9％。G^＋球菌中，以凝固酶阴性葡萄球菌（CNS）分离率最高，占G^＋球菌的57.0％（929／1629）。甲氧两林耐药株分别占金黄色葡萄球菌（SA）和CNS的55．1％和61.7％；尚未发现万古霉素耐药或中介菌株。葡萄球菌对强力霉素的敏感性仅次于万古霉索，耐药率仅为2．8％～4．4％，而对红霉素、复方新诺明、阿齐霉素的耐药率达73.3％～88．6％。结论 葡萄球菌、肠杆菌科细菌、铜绿假单胞菌、鲍曼不动杆菌及肠球菌是湘雅医院临床分离的主要病原菌。临床分离菌株耐药性已十分严重，应加强耐药性监测、合理应用抗菌药物。

Objective To investigate the distribution and drug resistance profiles of clinical isolates in Xiangya hospital in 2003 and to provide guidance for the proper use of antibiotics. Method Bacteria identification and susceptibility test were performed by Microscan system and K - B disk method, and the statistical analysis was performed by SPSS software. Results Among the 3,747 clinical isolates collected in 2003 from Xiangya hospital, gram- negative bacilli（G^- ）and gram - positive cocci （G^＋ ） accounted for 54.8 % （2,052/3,747） and 43.5 % （ 1,629/3,747 ） respectively. The Pseudomonsa aeruginosa, Escherichia coil, Klebsiella pneumonia, Acinetobacter baumannii and Enterobacter cloacae were the most common pathogens among the gram- negative bacilli. The resistance rate of these strains to meropenem was only 0% -6.4%, which was the lowest; and followed by cefoperazone/sulbactam. The resistance rate of gram - negative bacilli to other common antibiotics was from 4.4 % to 85.9 %. The coagulase negative Staphylococci （CNS） accounted for 57.0 % （929/1,629）, which was the most common among the G^＋ cocci. Among Staphylococcus aureus （SA） and CNS, resistant isolates to methicillin accounted for 5,5. 1% and 61.7% respectively; but the vancomycin - resistant （VRE） or intermediate strains were not found, Deoxycycline was the effective antibiotics against Staphylococcus second to vancomycin. The resistance rate was 2.8%-4,4%, andthe resistance rate to erythromycin, SMZ TMPandazithromycinwasfrom73.3% to88.6%. Conclusion Staphylococcus, Enterobacteriaceae, Pseudomonsa aeruginosa, Acinetobacter baumannii and Enterococcus are the most common pathogens isolated from Xiangya hospital, and the drug resistance profiles of clinical isolates are substantial. We should strengthen resistance monitoring of clinical isolates and use antibiotic reasonably.