医院常见病原菌分布及其耐药性分析

Analysis of the Distribution and Antibiotic Resistance of Common Pathogenic Bacteria in Hospital

目的了解本院近9年常见病原菌分布及近1年常见致病菌的耐药情况。方法用API半自动微生物鉴定系统进行鉴定及药敏试验。结果13 942份临床标本中共分离出病原菌3 723株,阳性率26.7%,病原菌分布于38个属,107个种。革兰阴性菌构成比高于革兰阳性菌。最常见的病原菌是凝固酶阴性葡萄球菌(CNS),占15.7%,其次是金黄色葡萄球菌、大肠埃希菌、假单胞菌属、不动杆菌属。葡萄球菌对万古霉素、奎奴普丁/达福普汀、呋喃妥因、米诺环素、夫西地酸、替考拉宁及利福平敏感,而对青霉素、苯唑西啉和红霉素耐药率高达80%以上。肠球菌及链球菌对多种抗生素耐药,如对红霉素及氯林可霉素耐药率高达88%以上,但对万古霉素最敏感。各主要致病革兰阴性菌(沙门菌除外)对亚胺培南、美洛培南及阿米卡星均敏感,而对庆大霉素、头孢噻吩及头孢呋辛耐药率均在60%以上。沙门菌属则对多种抗生素敏感。结论本院近9年病原菌以革兰阴性菌为主,除沙门菌外,均存在严重耐药问题,及时监测病原菌变化及耐药趋势对指导临床用药至关重要。

Objective To investigate the distribution of common pathogenic bacteria during the past nine years, and to observe the antibiotic resistance of common pathogenic bacteria in the last year in our hospital. Methods The API half- automicroscan system was used to identify the pathogenic bacteria and conduct antibiotic susceptibility test. Results A total of 3723 pathogenic bacteria were isolated from 13942 clinical samples. The positive rate was 26.7%. Pathogenic bacteria were distributed in 38 genera and 107 species. Gram - negative bacteria remained the more frequent pathogens than Gram- positive bacteria. Coagulase negative Staphylococcus（CNS） （15.7% of the isolates） was the most frequently isolated pathogen, followed by Staphylococcus anreus, Escherichia coli, Pseudomonas spp and Acinetobacter spp. Staphylococcus spp were sensitive to vancomycin, quinupristin / dalfopristin, nitrofurantoin, minocycline, fusidic acid, teicoplanin and rifampin. The resistance rate of Staphylococcus spp to penicillin, oxacillin and erythromycin was more than 80%. Enterococcus and Streptococcus were resistant nst various antibiotics obviously, and the resistance rate of them to erythromycin and clindamycin were more than 88%. Enterococcus and Streptococcus were especially sensitive to vancomycin. The dominant Gram- negative pathogenic bacteria（ except Salmonella spp ） were sensitive to imipenem, meropenem and amikacin. The drug resistance rate of dominant Gram - negative pathogenic bacteria to gentamicin, cephalothin and cefuroxime were more than 60%. Salmonella spp was sensitive to various antibiotics. Conclusions The Gram - negative bacteria plays a dominant role in clinical pathogens. Except Salmonella, drug resistance of isolated pathogenic bacteria is a serious problem. Monitoring the trends of pathogenic bacteria＇ s distribution and drug resistance will be very important in guiding the clinical administration of drugs.