临床感染病原菌菌种分布及其耐药性分析

Distribution and antimicrobial resistance of pathogens causing clinical infection:An analysis of author's hospital

目的了解笔者所在医院2008年度临床感染病原菌的菌种分布及其耐药现状。方法用VITEK微生物自动鉴定仪鉴定菌种,纸片扩散法检测临床分离菌对各种抗菌药物的敏感性,判读标准参照当年的CLSI M100文件。结果临床分离的1900株病原菌中革兰阴性杆菌、革兰阳性球菌和真菌所占比例分别为68.42%、18.16%和12.32%。分离率最高的五种病原菌:铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和白色假丝酵母菌,占所有分离病原菌的59.26%,排前20位的病原菌则占到近90%(89.63%)。革兰阴性杆菌仅对亚胺培南、头孢哌酮/舒巴坦、美洛培南、哌拉西林/他唑巴坦的平均耐药率低于30%,铜绿假单胞菌和鲍曼不动杆菌对亚胺培南、美洛培南的耐药率分别28.9%、32.9%和11.6%、24.7%,大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌的ESBL阳性率分别是52.8%、37.2%和34.6%,金黄色葡萄球和凝固酶阴性葡萄球菌中耐甲氧西林株各占44.0%和60.0%,未检出万古霉素中介或耐药的葡萄球菌,检出万古霉素耐药的粪肠球菌和屎肠球菌各1株。念珠菌对氟康唑耐药率接近5%。结论临床感染病原菌构成变化不大,但真菌检出率逐年升高。非发酵菌耐药率最低的是头孢哌酮/舒巴坦,肠杆菌科耐药率最低的是亚胺培南,ESBL的阳性率逐年升高。加强病原菌及其耐药性检测和监测,对病原学诊断及指导合理选用抗生素具重要参考价值。

Objective To investigate the distribution and antimicrobial resistance of pathogens causing clinical infection in author＇s hospital in 2008. Method The VITEK-AMS were used to identify pathogens. Antimicrobial susceptibility test was carried by Kirby-Bayer method and the obtained results were analyzed according to CLSI Mi00 documents. Result Of the 1 900 clinical isolates, Gram negative bacilli, Gram positive cocci and fungi accounted for 68.42%, 18.16% and 12.32%. The total rates of 5 kinds of pathogens, P. aeruginosa, E. coli, K. peumoniae, A. baumannii and C. albicans accounted for 59.26%. The total rates of the most common 20 kinds of pathogens accounted for 89.63%. There were only Imipenem, Cefoperazone-sulbactam, Meropenem and Piperacillin-tazobactam to which the average resistance rates of Gram negative bacilli were lower than 30%. However, 28.9%, 32.9% and 11.6% and 24.7% of P. aeruginosa stains and A. baumannii stains were resistant to Imipenem and Meropenem. ESBLs-producing strains accounted for 52.8% in E. coli and 37.2% in K. pneumoniae and 34.6% in P. mirabili,＊. About 44.0% of S. aureus isolates were identified as methicillin-resistant Staphylococcus, 60.0% coagulase negative Staphylococcus （CNS） isolates were methicillin-resistant. No vancomycinresistant strain was found, 1 strain of E. faeca!is and 1 strain of E. faecium were identified as VRE. The resistance rate Of Candida to Fluconazole was nearly 5%. Conclusion There were not obvious changes in structure of pathogens in recent years. However, the infections caused by fungi were increasing. Cefoperazonesulbactam is highly active for Nonfermenters and Imipenem is still highly active for Enterobactericaeae. The rates of ESBLs-producing strains are increasing. The data will be useful for diagnosis of disease and rational use of antimicrobial agents.