2008年重庆医科大学附属第一医院临床病原菌分布和耐药性分析

Surveillance and analysis of antibiotic resistance in clinical isolates from The First Affiliated Hospital of Chongqing University of Medical in 2008

目的了解2008年本院病原菌的分布和耐药性。方法对2008年临床送检标本按常规进行病原菌分离,采用VITEK2和ATBExpress系统对病原菌进行鉴定,并测定其相应抗生素的耐药性。结果临床分离9045株菌中,革兰阴性杆菌占63.9%,革兰阳性球菌占26.9%,真菌占10.2%。革兰阳性球菌感染比例下降,而革兰阴性杆菌感染中以铜绿假单胞菌和鲍曼不动杆菌上升最明显。药敏结果显示大肠埃希菌、肺炎克雷伯菌等常见肠杆菌科细菌对亚胺培南、美洛培南、阿米卡星、哌拉西林/他唑巴坦等抗生素的耐药率较低。铜绿假单胞菌和鲍曼不动杆菌对上述碳青霉烯类抗生素的耐药性分别是29.81%、22.54%、45.36%和13.64%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中耐甲氧西林株分别占56.48%和94.27%,未发现耐万古霉素菌株。葡萄球菌和肠球菌等革兰阳性球菌对万古霉素、替考拉宁、利奈唑烷具有高敏感性,白假丝酵母菌对常用的真菌药物敏感性较高。结论本院临床感染的病原微生物种类以革兰阴性杆菌为主,其中铜绿假单胞菌和鲍曼不动杆菌分离率较高,对碳青霉烯类抗生素耐药性较以往有所升高。

Objective To investigate the distribution and antibiotic resistances profile of clinic isolated from The First Affiliated Hospital of Chongqing Medical University during 2008. Methods The microorganisms were isolated from clinical samples according to the guides of standard operation protocol. Identification and antibiotic sensitivity tests were done by VITEK2 and ATB Express system. Results Of the 9 045 clinical isolates,gram negative rods,gram positive coccus and fungus accounted for 63.9%, 26.9G and 10.2% respectively, the rate of infection caused by gram positive coccus was decreasing, while the rate of infection caused by the P aeruginosa and A baumanii was increasing significantly. The result of antibiotic resistance showed that the common Enterobacteriaceae spp such as E coli, K pneumoniae were highly sensitive to Imipenem, Meropenem, Amikaein,Piperaeillin-tazobaetam. However,29.81% ,22.55% and 45.36% ,13.64% of P aeruginosa and A baumanii were resisitant to the above carbapenems, respectively. About 56.48% of Staphylococcus aureus isolates were identified as methocillin-resistant Staphylococcus, 94. 27% of eoagulase negative Staphylococcus （CNS） isolates were methocillin-resistant. No vancomycin- resistant strain was found. Staphylococcus spp and Enterococeus spp were highly sensitive to Vancomycin,Teicoplanin, Nitrofurantoin. Candidat albicans were totally sensitive to the common antifungus drug. Conclusion The major clinical pathogenic microorganisms in our hospital were Gram negative rods with the high isolating rates of P aeruginosa and A baumanii. The resistance rates to carbapenem in P aeruginosa and A baumanii were more serious than before.