2006～2010年某医院细菌分布及耐药分析

Distribution and drug resistance of bacteria in a hospital from 2006 to 2010

目的掌握该院细菌的分布及耐药情况。方法收集2006年1月1日～2010年12月31日来该院就诊患者的各种标本分离的非重复菌株,用WHONET5.4软件进行数据分析。结果 5年共分离菌株6 668株,其中革兰阴性杆菌(G-)4 267株(63.99%),主要有大肠埃希菌1 342株(20.04%)、肺炎克雷伯菌982株(14.66%)和铜绿假单胞菌652株(9.77%);革兰阳性球菌(G+)1 809株(27.00%),主要为金黄色葡萄球菌777株(11.60%)、凝固酶阴性葡萄球菌491株(6.88%)和真菌622株(9.29%)。病原菌标本来源前3位为痰液(41.36%)、分泌物(23.08%)和尿液(13.05%)。G-杆菌中,未发现耐碳青霉烯类的大肠埃希菌和肺炎克雷伯菌,但不动杆菌及铜绿假单胞菌对美罗培南耐药率已达3.59%～12.42%;大肠埃希菌及肺炎克雷伯菌对氨苄西林耐药率大于72.00%,对其较敏感的抗菌药物有哌拉西林/他唑巴坦和阿米卡星(<25%)。不动杆菌及铜绿假单胞菌对庆大霉素、妥布霉素和哌拉西林的耐药率已达61.85%～94.77%,对其较敏感的抗菌药物为头孢吡肟和哌拉西林/他唑巴坦(<27%)。未发现对万古霉素耐药的葡萄球菌,但该类病原菌对其他常用抗菌药物耐药率较高,对青霉素和阿奇霉素的耐药率大于80%。结论以G-杆菌为主的细菌耐药性较高,但近年来得到了较好的控制,开展耐药性监测,指导临床合理应用抗菌药物具有重要意义。

Objective To investigate distribution and drug resistance of bacteria in this hospital.Methods All of non-repetitive strains,isolated from kinds of samples of hospitalized patients during January 1st,2006 to December 31st,2010,were collected.The data were analyzed by WHONET5.4 software.Results 6 698 strains of pathogenic bacteria were isolated,including 4 267（63.99%） gram-negative（G-） strains,1 809（26.68%） gram-positive（G＋） strains and 622（9.33%） fungi.Most common isolates were Escherichia coli for 1 342（20.04%） stains,Klebsiella pneumoniae for 982（14.66%） strains,Pseudomonas aeruginosa for 652（9.77%） strains,Staphylococcus aureus for 777（11.60%） strains and coagulase-negative Staphylococci for 461（6.88%） strains.The top three kind of bacteria positive specimens were sputum（41.36%）,secretion（23.08%） and urine（13.05%）.NO carbapenems-resistant Escherichia coli and Klebsiella pneumonia were detected,but 3.59%-12.42% of Acinetobacter and Pseudomonas aeruginosa isolates were meropenem-resistant.More than 72% of Escherichia coli and Klebsiella pneumoniae were resistant to ampicillin,while the resistant rate to piperacillin/tazobactam and Amikacin was less than 25%.Acinetobacter and Pseudomonas aeruginosa isolate were resistant to gentamicin,tobramycin and piperacillin,with resistance rate of 61.85%-94.77%,but were still sensitive to cefepime and piperacillin/Tazobactam,with resistance rate less than 27%.Though there were no vancomycin-resistant Staphylococcus detected,their resistance rate to the other commonly used antimicrobial agents was so high that more than 80% Staphylococcus were resistant to penicillin and azithromycin.Conclusion G-bacteria might be with high drug resistance rate,but in recent years,it had been better controlled.Besides,surveillance of drug resistance and rational use of antibiotics might be important.