湖南衡阳地区医院常见病原菌分布及其耐药性分析

Analysis of the distribution and antibiotic resistance of common nosocomial pathogens from Hengyang region,Hunan

目的了解南华大学附属第一医院近9年常见病原菌分布及近1年常见致病菌的耐药情况。方法用API半自动微生物鉴定系统进行鉴定及药敏试验。结果13942份临床标本中共分离出病原菌3723株,阳性率26.7%,检出病原菌分布于38个属,107个种。革兰阴性菌构成比高于革兰阳性菌,最常见的病原菌是凝固酶阴性葡萄球菌(CNS)菌,占15.7%,其次是金葡菌、大肠埃希菌、假单胞菌属、不动杆菌属。葡萄球菌对万古霉素、奎奴普丁/达福普汀、呋喃妥因、米诺环索、夫西地酸、替考拉宁及利福平敏感,但对青霉素、苯唑西林和红霉素耐药率高达80%以上。肠球菌及链球菌耐药情况严重,对多种抗生素耐药,其中对红霉素及氯林可霉素耐药率高达88%以上。但对万古霉素最敏感。各主要致病革兰阴性菌对亚胺培南、美洛培南及阿米卡星(沙门菌除外)均敏感,但对庆大霉素、头孢噻吩及头孢呋辛耐药率均在60%以上。沙门菌属则对多种抗生素敏感。结论临床病原菌以革兰阴性菌为主。检出菌中除沙门菌外,均存在严重耐药问题,及时监测病原菌变化及耐药趋势以指导临床用药至关重要。

Objective To investigate the distribution of common pathogenic microbes during the last nine years, and observe the antibiotic resistance of common pathogenic bacteria last year in our hospital. Methods The API half-automicroscan system was used to identify the pathogenic microbes and conduct antibiotic susceptibility test. Results A total of 3, 723 pathogenic microbes were isolated and collected from 13,942 clinical samples. The positive rate was 26.7%. Pathogenic microbes were distributed in 38 genera and 107 species. Gram-negative bacteria remained the more frequent than Gram-positive bacteria. Coagulase negative Staphylococcus （15.7% of the isolates） was the most frcquently isolated pathogens, followed by Staphylococcus aureus, Escherichia coli, Pseudomonas and Acinetobacter. Staphylococci were sensitive to vancomycin, quinupristin/dalfopristin, nitrofurantoin, minocycline, fusidic acid, teicoplanin and rifampicin. The resistance rate of Staphylococcus to penicillin, oxacillin and erythromycin was above 80%. Enterococcus and Streptococcus were obviously resistant against various antibiotics, and their resistance rate to erythromycin and clindamycin were above 88%. Enterococcus and Streptococcus were especially sensitive to vancomycin. The dominant Gramnegative pathogenic bacteria were sensitive to imipenem, meropenem and amikacin （except Salmonella spp）. The drug resistance rate of dominant Gram-negative pathogenic bacteria to gentamicin, cephalothin and cefuroxime were above 60%. Salmonella was sensitive to various antibiotics. Conclusions The Gram-negative bacteria played a dominant role in clinical pathogens. Except Salmonella, drug resistance of isolated pathogenic bacteria was a serious problem. Monitoring the trends of pathogenic bacteria＇s distribution and drug resistance was very important in guiding the clinical administration of drugs.