对老年住院患者连续三年分离致病菌耐药性监测的分析

Antibiotic resistance of clinical isolated bacteria in elderly inpatients in recent 3 years

目的了解2006—2008年我院老年患者分离菌株对常用抗菌药物的耐药性。方法采用纸片扩散法，对老年患者分离菌5710株进行药物敏感性试验，WHONET5．4统计软件对数据进行分析。结果分离革兰阴性杆菌前3位分别为铜绿假单胞菌、大肠埃希菌和嗜麦芽窄食单胞菌；革兰阳性球菌前4位分别为金黄色葡萄球菌、凝固酶阴性葡萄球菌、肺炎链球菌及肠球菌属。体外药物敏感性试验结果显示，121株肺炎链球菌中，19株为青霉素不敏感株，占15．7％；690株金黄色葡萄球菌中，对甲氧西林耐药的金黄色葡萄球菌占80．2％；未发现对万古霉素不敏感的葡萄球菌。分离到114株粪肠球菌和95株屎肠球菌，屎肠球菌的耐药性高于粪肠球菌，其中对万古霉素耐药的肠球菌19株。2006年、2007年和2008年产超广谱β-内酰胺酶（ESBLs）大肠埃希菌分离率分别为41．7％、55．0％和56．8％，肺炎克雷伯菌分别为16．0％、22．4％和27．3％，产ESBLS菌株的耐药性远高于非ESBLS菌株。铜绿假单胞菌和不动杆菌属已出现多重耐药株。结论老年患者分离致病菌耐药性高于非老年平均水平。定期进行耐药监测有助于了解老年患者细菌耐药性变迁，为临床经验用药提供理论依据。

Objective To analyze the antibiotic resistance of clinical isolated bacteria in elderly inpatients in Beijing Hospital from 2006 to 2008. Methods A total of 5710 strains isolated from elderly inpatients received antibiotic sensitivity test （AST） by using K-B method, and the data were analyzed with WHONET 5.4 software. Results During the 3 years, in constituent ratio of bacteria, P. aeruginosa, E. coli and Stenotrophomonas maltophilia were at the top of gram-negative bacteria. And S. aureus, coagulase-negative Staphylococcus （ CoNS ）, S. pneumoniae and Enterocoeeus spp. were at the top of gram-positive bacteria. The results of AST in vitro showed that 19 of 121 strains of S. pneumoniae were penicillin-insensitive S. pneumoniae （PNSP）. In 690 strains of S. aureus, the methicillin-resistant S. aureus （MRSA） ratio was 80.2%, and vancomyciwinsensitive strains were not found. And 114 strains of Enterococcus faecalis and 95 strains of Enterococcus faecalis were isolated, while the antibiotic resistance of the latter was stronger than the former, and 19 strains were vancomycin resistant strains. The detection ratios of E. coli producing ESBLs were 41.7%, 55.0% and 56.8%, and the detection ratios of Ktebiella pneumonia producing ESBLs were 16.0%, 22.4% and 27.3%. The antibiotic resistance of ESBL-producing bacteria was much stronger than non-ESBLs producing bacteria. Multi-antibiotic resistant strains of Pseudomonas aeruginosa and Acinetobacter spp. were found. Conclusions It is necessary to detect the drug-resistant strains periodically for understanding the changes in bacterial resistance and providing a theoretical basis for the medication by the clinical experience.