泰安市病原菌临床分布特征及耐药性分析

Analysis on Clinical Distribution Characteristics and Antimicrobial Resistance of Bacteria in Tai'an City

[目的]回顾性分析临床分离常见病原菌分布特征及对常用抗菌药物的耐药情况,为临床预防和合理用药提供科学依据。[方法]2007年应用ATB半自动分析仪按《全国临床检验操作规程》对泰安市某医院临床分离的1 366株菌株进行菌种鉴定,采用K-B纸片扩散法进行药敏试验,结果用WHONET 5.40软件进行统计分析。[结果]2007年1-12月某医院送检的1 366株临床分离的病原菌中,革兰阳性（G＋）球菌291株（占27.60%）,革兰阴性（G-）杆菌597株（占43.70%）,真菌133株（占9.70%）;除真菌外的888株病原菌中,位列前6位的细菌分别是耐甲氧西林凝固酶阴性葡萄球菌（MRSA）（占13.25%）、大肠埃希菌（占12.96%）、铜绿假单胞菌（占11.20%）、鲍曼不动杆菌（占8.27%）、MRC-NS（占8.05%）、肺炎克雷伯菌（占7.17%）。药敏显示G＋球菌对万古霉素和替考拉宁的耐药率为0.00%;G-杆菌中大肠埃希菌和肺炎克雷伯菌对碳青霉烯类包括美洛培南（MEM）、亚胺培南（IPM）耐药率均为0.00%;产ESBLs大肠埃希菌和肺炎克雷伯菌对复方新诺明、左氧氟沙星耐药率均较非产ESBLs细菌的耐药率高,分别为86.70%、84.30%和58.30%、56.70%。[结论]万古霉素、替考拉宁对G＋球菌始终保持着高活性,未发现万古霉素耐药的葡萄球菌;碳青酶烯类是肠杆菌科细菌活性最好的药物。

[Objective]To analyze the distribution characteristics and antimicrobial resistance of bacteria in Tai＇an city,so as to provide scientific basis for clinical prevention and rational drug use.[Methods]ATB half-automated system was applied to identify clinical isolated strains by ＂national clinical laboratory procedures ＂and drug sensitive assays were done by K-B disc diffusion.Data were analyzed by WHONET 5.4 software.[Results]Among 1 366 pathogen strains,291 were G＋ bacteria（27.60%）,597 were G-bacilli（43.70%）,and 133 were fungi（9.70%）.The leading six strains among 888 pathogens except fungi were MRSA（13.25%）,Escherichia coli（8.60%）,Pseudomonas aeruginosa（11.20%）,Acinetobacter baumanni（8.27%）,MRCNS（8.05%）,and Klebsiella pneumoniae（7.17%）.Antimicrobial resistance results showed that the resistance rates of G＋ bacteria to penicillin and Proctaphlin Sodium were about 100%,but no G＋ bacteria resistance to vancomycin and linezolid.The antimicrobial resistance rates of G-bacilli to carbapenems including imipenem and meropenem were very low,and the antimicrobial resistance rates of extended-spectrum-lactamases（ESBLS＋）in Escherichia.coli and K.pneumoniae were higher than that of ESBLs-.[Conclusion]Vancomycin and teicoplanin maintain high activity against G＋ bacteria,as well as carbapenams against enterobacteriaceae.