3144株临床分离细菌和念珠菌的分布及耐药性分析

Distribution and Drug Resistance Spectrum of 3144 Bacteria and Candida Clinical Isolates

目的了解本院临床分离细菌和念珠菌的分布特征和耐药性,为合理使用抗生素提供依据。方法大多数分离细菌的鉴定和药敏试验利用BD Phoenix仪,少数利用手工鉴定和K-B法。念珠菌利用显色平板进行分离和鉴定,K-B法测药敏。结果3144株细菌和念珠菌中前6位的种类及百分比为白色念珠菌12.02%、铜绿假单胞菌11.10%、大肠埃希菌9.64%、金黄色葡萄球菌7.09%、表皮葡萄球菌6.36%和肺炎型肺炎克雷伯菌6.14%。G-杆菌中耐药率较低的为亚安培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和阿米卡星。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的检出率为44.2%和43.5%。G+球菌耐药率较低的为万古霉素、替考拉宁、呋喃妥因、阿米卡星、氯霉素、头孢哌酮/舒巴坦和哌拉西林/他唑巴坦。金黄色葡萄球菌和凝固酶阴性葡萄球菌对甲氧西林耐药率分别为52.1%和65.1%。念珠菌对两性霉素B和制菌霉素的耐药率均为0。结论本院临床分离肠杆菌科各种细菌产ESBLs水平、非发酵菌耐药率和葡萄球菌对甲氧西林耐药率均较高,应加强抗生素的合理使用。

Objective To investigate distribution and drug resistance spectrum of clinical isolates of bacteria and Candida in local region. Method Most bacteria isolates were identified by BD Phoenix, and a few were identified by K-B method. Candida isolates were identified by color display plate and by K-B method. WHONET5.4 software was used for data analysis. Result The common isolates in 3144 samples were C.albicans （12.02%）, P. aeruginosa （11.10%）, E.coli （9.64%）, S.aureu （7.09%）, S.epidermidis （6.36%）, and K.pneumoniae （6.14%）. Gram negative isolates showed lower resistant rate to Imipenem, Piperacillin/Tazobactam, Cefoperazone/Sulbactam, and Amikacin. The incidences of E.coli and K.pneumoniae isolates producing extended spectrum beta-lactamase （ESBLs） were 44.2% and 43.5%, respectively. Gram positive isolates showed a lower resistant rate to Vancomycin, Teicoplanin, Nitrofurantoin, Amikacin, Chloramphenicol, Cefoperazone/Sulbactam, and Piperacillin/Tazobactam. The methecillin resistant rates of S.aureu and coagulase negative staphylococcus were 52.1% and 65.1%, respectively. In Cand/da isolates, resistant rates of Amphotericin B and Nystain were both 0. Conclusion The production ratio of ESBLs, multi-drug resistance of non-fermenters and methecillin resistance of staphylococcus in local region were high. It is important to promote the rational use of antimicrobial agents.