医院感染病原菌的分布及耐药性分析

Distribution and Antibacterial Resistance of Nosocomial Infection Pathogens in Hospital

目的调查医院感染病原菌的分布及耐药趋势,为指导临床用药及控制医院感染提供依据。方法对2004年1月-2005年12月住院患者各类标本中分离出的病原菌,采用自动微生物分析仪ATB Expression及配套试剂进行细菌鉴定和药敏实验。结果共分离病原菌3 066株(真菌除外);革兰阳性球菌927株(30.2%),以葡萄球菌属为主,其中耐甲氧西林株分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的69.0%和77.6%,未发现耐万古霉素菌株;革兰阴性杆菌2134株(69.6%),以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌和阴沟肠杆菌多见;30.1%大肠埃希菌和40.1%肺炎克雷伯菌证实产ESBLs;革兰阴性杆菌对碳青酶烯类耐药率最低,其次为头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和头孢吡肟,但对部分抗菌药物产生多重耐药。结论医院感染的耐药问题日趋严重,定期进行细菌耐药性监测,对指导临床合理应用抗菌药物,积极有效地控制医院感染具有重要意义。

OBJECTIVE To investigate the tendency of bacterial distribution and resistance of hospitial infections, and to provide the reference for the clinical treatment and infection control in hospital. METHODS Bacteria isolated from patients in our hospital from Jan 2004 to Dec 2005 were identified by ATB expression, and bacterial susceptibility tests were performed on strains using Kirby-Bauer method. RESULTS A total of 3066 pathogens strains were isolated,among them 927 strains were Gram-positive cocci（30.2 %）. The most common pathogens of them were Staphylococcus. Meticillin resistant strains of Staphylococcus aureus and coagulase negative Staphylococcus （CNS） accounted for 69. 0K and 77. 6%, respectively. In our data, no vancomycin resistant S. aureus were isolated. There were 2134 strains of Gram-negative bacilli（69.6 % ）, the most common pathogens of them were Pseudornonas aeruginosa, Escherichia coli, Klebsiella pneurnoniae, Acinetobacter baurnannii and Enterobacter cloacae. The ESBLs producing strains of E. coli and K. pneurnoniae accounted for 30. 1% and 40. 1% , respectively. The highest susceptible to Gram-negative bacilli was carbapenem, then were cefoperazone/ sulbactam, piperacillin /tazobactam and cefepime. Mainly pathogenic bacteria were multi-resistant to some antibiotics. CONCLUSIONS Drug resistance of the nosocomial infection bacteria is a serious problem. It＇s important and urgent to carry out surveillance of bacterial resistance for appropriate using of antibiotics and effective controlling nosocomial infections.