天津市胸科医院2008-2009年临床分离病原菌对抗菌药耐药状况分析

Analysis of resistance of clinical isolated pathogens to antibacterials in Tianjin Chest Hospital from 2008 to 2009

目的:调查天津市胸科医院主要临床分离病原菌的种类分布及耐药趋势,为制定抗菌药物临床用药干预措施提供参考。方法:对本院2008-2009年分离菌株的种类及其药敏结果作回顾性分析。结果:主要菌种所占比例:肺炎克雷伯菌18.27%,铜绿假单胞菌13.98%,金黄色葡萄球菌12.92%,鲍曼不动杆菌10.97%。金黄色葡萄球菌和表皮葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林表皮葡萄球菌(MRSE)分别为61.9%和57.8%,溶血葡萄球菌100%为甲氧西林耐药株,葡萄球菌对万古霉素100%敏感,MRSE和耐甲氧西林溶血葡萄球菌(MRSH)对莫西沙星的耐药率均<10%。大肠埃希菌、肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)株分别为64.6%和30%,这两种菌对碳青霉烯类药物最敏感。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为30.6%和28.4%,对阿米卡星、哌拉西林钠/他唑巴坦钠、头孢他啶、头孢吡肟、环丙沙星、左氧氟沙星较敏感,对其他药物敏感率均<70%。鲍曼不动杆菌对亚胺培南、美罗培南、阿米卡星、哌拉西林钠/他唑巴坦钠的耐药率均<15%。结论:肠杆菌科细菌对碳青霉烯类药物最为敏感,但非发酵G-杆菌对碳青霉烯类耐药率呈上升趋势;葡萄球菌属中均未发现耐万古霉素菌株。应加强对临床病原菌的耐药监测及预警,以指导临床合理应用抗菌药物。

Objective： To investigate the current distribution of pathogens isolated from clinic in Tianjin Chest Hospital and their antibiotic susceptibility,and provide a reference for management of application of antibacterials.Methods： The species and results of susceptibility test of clinical isolated strains from 2008 to 2009 were retrospectively analyzed.Results： The rates of main strains detected were as follows：Klebsiella pneumoniae 18.27%,Pseudomonas aeruginosa 13.98%,Staphylococcus aureus 12.92%,Acinetobacter baumannii 10.97%,respectively.The rates of methicillin-resistant S.aureus（MRSA） and methicillin-resistant Staphylococcus epidermidis（MRSE） were 61.9% and 57.8% in S.aureus and S.epidermidis,respectively.All of the Staphylococcus haemolyticus isolated were resistant to methicillin and no Staphylococci strains were resistant to vancomycin.The resistant rate of MRSE and methicillin-resistant S.haemolyticus（MRSH） to moxifloxacin were less than 10%.The detection rates of extended spectrum β lactamases（ESBLs）-producing strains in Escherichia coli and K.pneumoniae were 64.6% and 30%,respectively.Most of E.coli and K.pneumoniae strains were sensitive to carbapenems.The resistant rates of P.aeruginosa to imipenem and meropenem were 30.6% and 28.4%,respectively.P.aeruginosa was sensitive to amikacin,pipemcillin sodium-tazobactam sodium,ceftazidime,cefepime,ciprofloxacin and levofloxacin,and its sensitive rates to other antimicrobials were less than 70%.The resistant rates of A.baumannii to imipenem,meropenem,amikacin,pipemcillin sodium-tazobactam sodium were less than 15%.Conclusion： Enterobacteria strains were the most sensitive to carbapenems,but the resistant rate of nonfermenting gram negative bacilli to carbapenems was increasing.None of Staphylococcus strains were found resistant to vancomycin.The monitoring and warning system of pathogens susceptibility need to be strengthened to promote the rational use of antimicrobials.