2005-2007年医院感染病原菌分布与耐药性分析

Distribution and Resistance of Clinical Pathogenic Bacterial Isolates in Our Hospital 2005-2007

目的了解医院临床分离病原菌谱及其耐药状况。方法对2005-2007年医院微生物室分离到的临床病原菌,用K-B法药敏试验的抑菌圈直径输入计算机,采用WHONET5软件进行统计分析,根据美国临床实验室标准化委员会(NCCLS)2005年标准判定耐药性。结果在3年间革兰阳性菌检出构成比有上升趋势,而革兰阴性菌有下降趋势;在2007年时革兰阳性菌检出构成比高于革兰阴性菌,凝固酶阴性葡萄球菌3年逐年增加,金黄色葡萄球菌有下降趋势,大肠埃希菌感染在2007年位居第2位;葡萄球菌属对青霉素的耐药率>92.2%,对红霉素、阿奇霉素的耐药率>52.2%;耐甲氧西林凝固酶阴性葡萄球菌>74.5%,明显高于金黄色葡萄球菌;肠球菌属对万古霉素的耐药率为1.1%;大肠埃希菌及克雷伯菌属对氨苄西林耐药率均很高;革兰阴性杆菌对亚胺培南及美罗培南开始出现耐药。结论2005-2007年检出病原菌存在严重耐药,及时监测病原菌变化及其耐药趋势以指导临床用药至关重要。

OBJECTIVE To investigate the distribution of clinical bacterial isolates and the change in antibiotic resistance spectrum in our hospital from 2005 to 2007. METHODS Data of bacterial susceptibility testing of clinical isolates from the Second Affiliated Hospital in of University of South China from 2005 to 2007 were collected and analyzed by software WHONET25. Results were assessed according to the National Committee for Clinical Laboratory Standards （NCCLS） of America issued in 2005. RESULTS The amount of Gram-negative bacteria decreased and of Gram-positive bacteria increased during this period. The proportion of coagulase negative Staphylococcus （CNS） had been increasing and reached 21. 7% in 2007. The proportions of Staphylococcus aureus decreased from 17. 6% in 2005 to 13. 0% in 2007. Escherichia were the top two bacteria in 2007. The drug resistance rate of staphylococci against penicillin and erythromycin was more than 92. 2% and 52. 2%, respectively. The oxacillin resistance rate of CNS was 74. 5%, significantly higher than that of S. aureus （16.5%）. Drug resistance rate of Enterococcus to vancomycin was 1.1%. Gram-negative bacteria were found resistant to meropenem and imipenem. The resistance rate to ampicillin of Klebsiella and Escherichia was very high. CONCLUSIONS The variation of drug resistance and distribution of clinical bacterial isolates in our hospital are related to the improper use of antibiotics. It is very important to select antibiotics correctly according to the results of antibiotics susceptibility tests.