医院常见致病菌菌群分布及其耐药性分析

Distribution and drug-resistance of common pathogenic bacteria in hospital

目的了解该院2006年分离的致病菌菌群分布及其耐药性，为细菌性感染的诊断提供参考依据。方法用VITEK—AMS60全自动微生物仪进行菌种鉴定和药敏试验，按NCCLS M7解释结果。结果分离出1363株细菌中，革兰阳性球菌占30．2％，革兰阴性杆菌占69．8％。分离率由高到低分别为铜绿假单胞菌（19．6％）、金黄色葡萄球菌（12．4％）、肺炎克雷伯菌（11．5％）、大肠埃希菌（11．2％）、不动杆菌属（6．7％）和嗜麦芽窄食单胞菌（4．6％）。葡萄球菌对万古霉素、利奈唑烷和呋喃妥因高度敏感，敏感率在98．0％以上。其中耐甲氧西林金黄色葡萄球菌占84．0％；大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌产超广谱β-内酰胺酶（ESBLs）的发生率分别为59．0％、40．0％、45．0％。大肠埃希菌、肺炎克雷伯菌、不动杆菌和阴沟肠杆菌对亚胺培南的敏感率均在92．0％以上，铜绿假单胞菌只对哌拉西林／他唑巴坦中度敏感，敏感率为65．0％，对其他13种抗菌药物耐药率均在66．0％～100．0％之间。结论细菌构成比与国内其他地区有一定差异，且多重耐药更为严重。建议临床医生根据细菌培养结果选用抗菌药物，以期减少耐药菌株的产生。

Objective To investigate the distribution and drug-resistance of common pathogenic bacteria in 2006 in our hospital, and to provide reference for the diagnosis of bacterial infection. Methods Bacteria were identified and drug susceptibility test was done by VITEK-AMS60 Automatic Microbial Identification System. NCCLSM7 file was regarded as the reference standard. Results A total of 1 363 strains were isolated, including gram negative bacilli （69.8%） and gram positive cocci （30. 2%）. The isolated rates of these strains from high to low were Pseudomonas aeruginosa （19.6 %）, Staphylococcus aureus （12.4 %）, Klebsiella pneumoniae （11.5 %）, Escherichia coli （11.2 % ）, Acinetobacter spp （6. 7 %） and Stenotrophomonas maltophilia （4. 6%） respectively. Staphylococcus was high susceptible for vancomycin, linezolid and nitrofurantion, with 98.0 % above of sensitive rate. The detection rate of methicillin-resistant Staphylococcus aureus （MRSA） accounted for 84.0%. The detection rates of extend-spectrum beta lactamases-producing of Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae were 59.0%, 40.0% and 45.0% respectively. Escherichia coli, Klebsiella pneumoniae, Acinetobacter spp and Enterobacter cloacae were above 92. 0% susceptible for imipenem. Pseudomonas aeruginosa was only medium susceptible for piperacillin/tazobactam with 65.0% of susceptibility rate. Its drug-resistant rates were between 66.0%-100.0% for the other 13 kind antibiotic agents. Conclusion The proportion ratio of isolated bacteria in our hospital is different from that of other civil regions, and the multiple drug resistance is more serious. It is suggested that antibiotics should be used by results of bacteria culture so as to decrease occurrence of resistant strains.