496例腹泻患者粪便细菌培养与耐药性分析

Bacterial culture on stools in 496 patients with diarrhea and antimicrobial resistance

目的分析西安地区第四军医大学唐都医院2004—2008年腹泻患者粪便标本分离的细菌种类及耐药性。方法采用Microscan WalkAway-40全自动微生物分析仪对上述标本菌株进行鉴定及药敏分析,药敏试验采用K-B纸片扩散法,结果根据美国临床实验室标准化研究所2006年版标准判定。结果粪便致病菌及异常优势菌培养阳性率为36.63%。检出的496株细菌中,革兰阳性(G^+)菌163株(32.86%),革兰阴性(G^-)菌299株(60.28%),真菌34株(6.85%);G^+菌以肠球菌属(154株,94.48%)为主,G^-菌以志贺菌属(136株,45.48%)为主。肠球菌属对利奈唑胺和万古霉素有较高敏感性,敏感率为96.10%～100.00%;志贺菌属对亚胺培南、头孢哌酮、头孢曲松和庆大霉素有较高敏感性,敏感率为81.62%～100.00%。结论了解腹泻患者粪便病原菌的分布特征及其耐药性,对有效控制感染及耐药菌株的产生具有十分重要的临床意义。

Objective To analyze the species and antimicrobial resistance of pathogens isolated from stool of patients with diarrhea in Tangdu Hospital, Fourth Military Medical University in Xi＇an between 2004 and 2008. Methods Microscan WalkAway-40 system was used to identify bacteria and analyze antimicrobial susceptibility. Antimicrobial susceptibility tests were performed with Kirby-Bauer method, results were judged according to the standard of Clinical and Laboratory Standards Institute （CLSI） in 2006. Results Positive rate of stool culture was 36. 63%. Among 496 isolated bacteria strains, 163 （32. 86%） were gram-positive bacteria, 299 （60. 28%） were gram-negative bacteria, and 34 （6. 85%）were fungus. The main gram-positive bacteria were Enterococci （154 strains, 94. 48%）, the main gram-negative bacteria were Shigella （136 strains, 45.48 %）. Enterococci were highly susceptible to linezolid and vancomycin, which was 96. 10% to 100. 00% ; while Shigella were highly susceptible to imipenem, cefoperazone, ceftriaxone and gentamycin, which was 81.62% to 100.00%. Conehtsion It is of great importance to understand the distribution characteristics and antimicrobial resistance of bacteria in stool for controlling infection and emergence of antimicrobial-resistant strains.