中医院近3年常见细菌耐药监测分析

Surveillance to drug resistance of the common bacteria in traditional chinese medicine hospital during past 3 years

目的调查近3年医院临床分离的病原菌分布和对常用抗菌药物的耐药性,为临床合理选用抗菌药物提供依据。方法纸片扩散法测定抗菌药物的敏感性,数据用WHONET 5.4软件进行统计分析。结果 2007至2009年共分离出细菌14 435株,其中革兰阴性菌占85.8%,革兰阳性菌占14.2%;革兰阳性菌以金黄色葡萄球菌分离最多,其中耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的连续3年检出率分别为44.6%、57.5%、68.8%和30.6%、31.8%、63.9%,无万古霉素耐药株;肠球菌中屎肠球菌对多数抗菌药物的耐药率>80.0%,粪肠球菌对多数抗菌药物敏感,仅对红霉素耐药率>70.0%,检出耐万古霉素的肠球菌属12株;肠杆菌科中分离率前2位的是大肠埃希菌、肺炎克雷伯菌,其中产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌检出率分别为65.9%和32.6%;非发酵菌中以铜绿假单胞菌、鲍氏不动杆菌最多,对多数抗菌药物的耐药率>90.0%,并检出多药耐药铜绿假单胞菌和泛耐药鲍氏不动杆菌。结论医院细菌耐药率呈逐年升高趋势,值得关注,加强细菌耐药性监测,合理使用抗菌药物。

OBJECTIVE To investigate the pathogens distribution and their drugs resistance in hospital during the past three years and provide rational suggestion of antibiotics use for clinical treatment.METHODS Disc diffusion test was employed to study the antimicrobial susceptibility.WHONET 5.4 was applied for the data analysis.RESULTS A total of 14 435 strains of bacteria were isolated during 2007-2009,including Gram-negative strains（85.8%） and Gam-positive strains（14.2%）.S.aureus was the top one of Gam-positive cocci.The detection rates of meticillin resistant S.aureus（MRSA） and meticillin resistant coagulase-negative staphylococci（MRCNS） in successive three years accounted for 44.6%,57.5%,68.8% and 30.6%,31.8%,63.9% respectively.Neither persister of vancomycin was found.The resistant rates of S.faecium to the most common antibiotics were higher than 80.0%.S.faecalies had the low resistance except to erythrocin（the resistance rate was more than 70.0%）.12 strains of vancomycin-resistant enterococci were isolated.The top two of Enterobacteriaceae were E.coli and K.pneumoniae.The detection rates of ESBLs of E.coli and K.pneumoniae in three years were 65.9% and 32.6% respectively.The top two non-fermenting bacteria were P.aeruginosa and A.baumannii and their resistance rates to the most common antibiotics were higher than 90.0%.Multiresistant P.aeruginosa and pan-resistant A.baumannii were isolated.CONCLUSION The resistance rate of the pathogens to commonly used antibiotics is increasing,which should pay more attention to the status,and enhance the surveillance to the drug resistance.