4262株医院感染病原菌的分布及耐药性分析

Pathogens from Nosocomial Infection Cases:Clinical Distribution and Drug Resistance Analysis of 4 262 Strains

目的了解4262株医院感染病原菌的临床分布及其对常用抗菌药物的耐药情况,以指导临床合理用药。方法收集医院2006年1-12月间临床住院患者的标本,进行微生物病原学分离、鉴定和药物敏感试验,同时对葡萄球菌属和革兰阴性杆菌分别进行MRSA、ESBLs的检测。结果在10573份标本中共分离出医院感染病原菌4262株,其中G^-菌2475株,占58.1%,G^＋菌695株,占16.3%,真菌1092株,占25.6%;3170株病原菌中,位列前5位的病原菌分别是铜绿假单胞菌（24.3%）、鲍氏不动杆菌（10.9%）、肺炎克雷伯菌（10.4%）、大肠埃希菌（8.9%）、金黄色葡萄球菌（8.0%）;病原菌分离阳性率较高的临床科室依次为神经外科、呼吸内科、ICU、肝胆外科、老年病科;病原菌耐药结果显示,金黄色葡萄球菌对克林霉素类、喹诺酮类、四环素类抗菌药物的耐药率均〉50%,但对万古霉素、替考拉宁、米诺环素的敏感度较高;G^-菌对亚胺培南、美罗培南、哌拉西林/他唑巴坦的耐药率较低,对其他常用抗菌药物的耐药率在30.0%～60.0%。结论医院感染病原菌主要为条件致病菌,仍以革兰阴性杆菌为主,真菌感染所占比例上升较快,病原菌耐药率普遍较高,因此,重视病原学检查及药敏监测,有助于临床合理选择和使用抗菌药物。

OBJECTIVE To determine the clinical distribution and drug resistance characteristics of pathogens from nosocomial infection cases to provide the gist for clinical therapy. METHODS Pathogens isolation, and identification and drug resistance tests were conducted for samples, which were gathered from inpatients in our hospital between Jan 2006 to Dec 2006. Then, MRSA tests were performed for Staphylococcus and ESBLs- producing G^- bacilli were also detected. RESULTS Among 4 262 strains pathogens from 10 573 samples, 2 475 strains were G^- bacilli （58.1%）, 695 strains were G^＋ bacteria （16.3%） and 1 092 strains were fungi （25.6%）. The most common species among 3 170 pathogen strains were Pseudomonas aeruginosa （24.3%）, Acinetobacter baurnannii （10.9%）, Klebsiella pneumoniae （10. 4%）, Escherichia coli （8. 9%） and Staphylococcus aureus （10. 7%）. The clinical departments with higher infective rate were Department of Neurosurgery, Department of Respiratory Disease, ICU, Department of Hepatobiliary Surgery, and Department of Geriatrics in order. Drug resistance results showed that the resistance rates of S. aureus to clindamycin, quinolones, and tetracyclines were more than 50%, but no S. aureus was resistant to vancomycin and minocycline. The resistance rates of G^- bacilli to imipenem, meropenem, and piperacillin/tazobactam were lower, but with 30-60% of resistance rates to other commonly used antibiotic drug. CONCLUSIONS The pathogens in nosocomial infection are mainly the opportunistic pathogenic bacteria and mostly G^- bacilli. The infection due to fungi shows an increasing trend. It should pay attention to the pathogenic detection and rational use of antimicrobial agent.