甘肃矿区临床细菌谱及药敏谱监测分析

SURVEILLANCE AND ANALYSIS OF CLINICAL BACTERIAL DISTRIBUTION AND ANTIBIOTICS SENSITIVITY SPECTRUM IN MINING AREA IN GANSU PROVINCE

[目的]探讨甘肃矿区临床细菌谱及药敏谱的变迁规律,提高临床首次应用抗生素的准确性,增强疗效,缩短病程。[方法]对1997年1月～2003年12月甘肃矿区临床分离270株病原菌的分布和耐药性进行回顾性统计分析。[结果]甘肃矿区临床分离革兰阳性菌已由1997年的29%上升为2003年的69%,表皮葡萄球菌(37%)、黏液口腔链球菌(19%)、大肠埃希氏菌(11%)的分离率明显增加,上升到临床分离细菌的前3位;金黄色葡萄球菌、凝固酶阴性葡萄球菌对青霉素耐药升至100%,大肠埃希氏菌、克雷伯氏菌、铜绿杆菌对复方新诺明、氨苄青霉素等耐药接近100%,肠球菌对大多数抗生素均耐药,但革兰阴性菌对头孢氧哌唑、丁胺卡那较敏感,革兰阳性菌没有普遍敏感的抗生素。[结论]甘肃矿区临床抗菌药物使用中的耐药性问题十分严峻,定期监测临床细菌谱及药敏谱的变迁对治疗细菌感染十分必要;应用抗菌药物时,需充分考虑细菌耐药性,提高首次用药的准确性,缩短病程,降低医药费用和因病误工损失,减缓细菌耐药性的增长,延长抗菌药物的使用寿命。

[Objective] To investigate the changing rules of clinical bacterial distribution and antibiotics sensitivity spectrum, so as to promote the correctness of first application of antibiotics to improve the therapeutic effects and shorten clinical disease course. [ Methods] The distribution and drug-resistance of 270 strains of clinical pathogenic bacteria isolated from 1997 to 2003 in mining area in Gansu Province were analyzed retrospectively. [ Results] The isolation rate of Gram-positive bacteria rose from 29% in 1997 to 69% in 2003. The isolation rates of Staphylococcus epidermidis （37%）, Stomatococcus mucilaginosus （19%） and Escherichia coli （11%） rose obviously, and they got to be the top three clinical isolated bacteria. The Penicillin resistance rates of staphylococcus aureus and coagulase negative staphylococcus were close to 100%. The rates of resistance to Compound Sulfamethoxazole and Ampicillin Sodium of Eseherichia coli, Klebsiella and Pseudomonas aeruginosa were close to 100%. Enteroeoccus had resistence to majority of antibiotics. Gram-negative bacteria were sensitive to Cefoperazone and Amikacin Sulfate, while Gram-positive bacteria were not sensitive to any antibiotics. [Conclusions] The problem of antibiotics resistance is very serious in clinical practice in mining area in Gansu Province. It is very necessary to monitor the changes of clinical bacteria distribution and antibiotics resistance spectrum regularly. And the drug-resistance of bacteria shotdd be considered sufficiently in application of antibiotics, in order to select drugs correctly and efficiently, shorten course of disease, de- crease medical expenses and loss of the delay of one＇s work, slow down the pace o f drug resistance and prolong the use of antimicrobial agents.