2008年～2009年西安地区临床标本病原菌分布与细菌耐药性分析

The distribution of clinical bacterial specimens and bacterial resistance analysis in 2008-2009 Xi'an district

目的:分析西安地区某三甲医院临床送检培养标本细菌分布及耐药性变迁,评价临床送检情况及临床抗生素使用的合理性。方法:收集统计临床送检各类培养标本(血液、尿液、痰液、粪便)各类分泌物等的数量、种类及送检科室,全自动细菌鉴定仪进行细菌鉴定,用NCCLS推荐的K-B法进行药物敏感试验,并对特殊耐药菌进行鉴定。结果:2008年送检标本种类前5位分别为痰液(65.2%)、1年中共收集患者首次分离菌1043株。其中真菌占45.5%,G—杆菌占42.3%,G+菌占11.6%。真菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、嗜麦芽窄食单胞菌、金黄色葡萄球菌为最常见,所占比例分别为45.5%、17.8%、6.7%、4.5%、4.0%、3.2%、3.6%。送检科室分布排列老年病科24.9%、心血管内科23.6%、呼吸科22.5%、门诊10.1%、肾内5.6%,其中G—菌中大肠埃希菌ESBLs占36.5%、肺克ESBLs占36.8%、葡萄球菌属中MRSA占31.3%、MRCNS占31.8%。2009年送检标本前5位分别为痰液(58.1%)、尿液(25.8%)、血液(5.8%)、粪便(5.4%)、分泌物(2.8%)。从临床标本中分离出病原菌1072株菌,其中真菌占41.5%,G—杆菌占46.1%,G+菌占12.3%。分离细菌为真菌、大肠埃希菌、肺炎克雷佰菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡葡球菌。所占比例分别为41.5%、23.5%、7.4%、4.9%、4.5%、4.4%。其中G—菌中大肠菌ESBLs占57.6%,肺炎克雷佰菌ESBLs占48.6%。G+菌中MRSA占42.9%,MRCNS占62.5%。碳青雷烯类仍是对G—杆菌(嗜麦芽单胞除外)抗菌活性最强的一类抗生素,大肠埃希氏菌和肺炎克雷伯菌中产ESBLs连续2年呈上升趋势,葡萄球菌中未发现万古霉素耐药,但MRS检出率上升趋势。真菌检出率连续2年第一,细菌耐药率上升。结论:2008年～2009年临床标本送检情况与病原菌分布基本一致。真菌检出率高。应提高临床标本送检率,加强实验室特殊耐药菌监测,合理使用抗生素,以减缓耐药株的蔓延,减少二重感染机会。

Objective To analysis the distribution and drug resistance evolution of clinical bacteria culture samples in a hospital in Xi＇an to evaluate the clinical specimens and the reasonable use situation of antimicrobial drug.Methods Various clinical cultures（blood,urine,sputum,s tool）were collected,the quantity and the category of the cultures were statistic.Automated bacterial identification system was used for bacteria identification.Drug susceptibility was tested by K-B method which recommended by NCCLS.The special resistant bacterial were identified. Results The top five categories of the cultures collected in 2008 were Sputum（65.2%）,Urine（23.2%）,Stool（4.3%）,Blood（2.9%）,Secretions（2.1%）.1 043 microbes were isolated from the secretions of patients for the first time in one year,with fungal（45.5%）,Gram-negative bacteria（42.3%）,Gram- positive bacteria（11.6%）.Fungi（45.5%）,Escherichia coli（17.8%）,Klebsiella pneumoniae（6.7%）,Acinetobacter baumannii（4.5%）,Pseudomonas aeruginosa（4.0%）,Stenotrophomonas maltophilia（3.2%）,Staphylococcus aureus（3.6%）was the most common.The distribution of the censorship departments：Department of geriatrics（24.9%）,Cardiovascular medicine（23.6%）,Respiratory（22.5%）,Patient（10.1%）,Renal（5.6%）,of which ESBLs of E.coli（36.5%）,Lung grams ESBLs （36.8%）, MRSA（31.3%）,MRSE（31.8%）.The top five categories of the cultures collected in 2009 were Sputum （58.1%）,Urine（25.8%）,Blood（5.8%）,Stool（5.4%）,Secretions（2.8%）.1 043 microbes were isolated from the secretions of patients,with fungal（41.5%）,Gram-negative bacteria（46.1%）,Gram-positive bacteria（12.3%）.Bacteria isolated were Fungi,Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,Staphylococcus aureus grape and The proportion was 41.5%,23.5%,7.4%,4.9 %,4.5%,4.4% separately.Escherichia coli which ESBLs accounted for 57.6% and the Klebsiella pneumoniae ESBLs accounted for 48.6% of G -bacteria.MRSA accounted for 42.9%,MRCNS 62.5% of G＋ bacteria.Carbapenems remains the antibiotics who have the most antibacterial activity about G＋ bacteria.Escherichia coli and Klebsiella pneumoniae producing ESBLs in an upward trend for two consecutive years,No Staphylococcu was found Vancomycin resistance,but there is an upward trend in the number of the MRS detection. Fungi detection rate was the First in two consecutive years,rate of bacteria resistant rised.Conclusion Clinical specimens was same to pathogens localities in 2008～2009.There was a high detection rate of fungi.Should increase the submission rate of clinical samples,Strengthen Monitor of Special resistant bacteria,Rational the use of antibiotics to slow the spread of resistant strains,reduce the Opportunities of superinfection.