医院感染革兰阳性球菌的耐药性及干预对策

Nosocomial infections caused by gram-positive cocci:antimicrobial resistance and intervention strategies

目的探讨医院感染革兰阳性球菌的构成比及耐药性,制定相关的医院感染干预对策。方法细菌培养与鉴定严格按照《全国临床检验操作规程》,采用常规方法进行;药物敏感试验采用CLSI推荐的K-B法,数据统计分析采用WHONET最新版本。结果 712株革兰阳性球菌中分离率居前3位分别为金黄色葡萄球菌、凝固酶阴性葡萄球菌、粪肠球菌,各占40.6%、31.9%、10.9%;革兰阳性球菌对常用抗菌药物表现出不同程度的耐药性,但对糖肽类抗菌药物万古霉素、替考拉宁100.0%敏感;MRSA检出率为60.9%,MRCNS检出率为61.2%。结论各级医疗机构应加大抗菌药物使用管理的力度,遏制细菌耐药率不断上升的不良趋势。

OBJECTIVE To study the constituent ratio and antimicrobial resistance of gram-positive cocci causing nosocomial infections in order to establish relative intervention strategies. METHODS Referring to National Guide to Clinical Laboratory Procedures,bacteria culture and identification were performed by the routine methods.The susceptibility test was performed by K-B method recommended by CLSI.The antimicrobial resistance profile was analyzed statistically by the latest version of WHONET software. RESULTS Among the 712 strains,the isolating rates of Staphylococcus aureus,coagulase-negative Staphylococcus,Enterococcus faecalis were 40.6%,31.9% and 10.9%,respectively.Gram-positive cocci were resistant to the commonly used antibiotics in varying degrees except for 100.0% susceptibility to vancomycin and teicoplanin.The detection rates of methicillin-resistant S.aureus（MRSA） and coagulase-negative Staphylococcus（MRCNS） were 60.9% and 61.2%,respectively. CONCLUSION Medical institutions should strengthen the antibiotic management to restrain the increasing tendency of resistance rates.