2005-2009年感染性疾病病原菌分布与耐药性变迁

Distribution and drug resistance of pathogens causing infectious diseases from 2005 to 2009

目的了解感染性疾病常见病原菌的分布特点及耐药性变迁,指导临床正确、合理地使用抗菌药物,减缓致病菌的增长速度,遏止其耐药趋势。方法采用微生物自动分析仪与手工相结合的方法,对2005-2009年医院所有送检标本分离出的病原菌进行分析。结果共检测标本93 547份,阳性标本24 353份,阳性率为26.03%;大肠埃希菌在临床分离的主要病原菌中位列各年第1位,且分离率呈上升趋势,2005-2009年分离率分别为17.4%、18.0%、22.0%、20.0%及23.0%;铜绿假单胞菌分离率分别为13.0%、14.0%、12.7%、13.4%及14.6%;大肠埃希菌对氨苄西林耐药率>80.5%;葡萄球菌属对常用抗菌药物均有不同程度的耐药,尤其对青霉素的耐药率最高可达98.6%;尚未发现万古霉素耐药株;产ESBLs大肠埃希菌及肺炎克雷伯菌的平均检出率为47.2%、27.2%,耐甲氧西林金黄色葡萄球菌的平均检出率为56.0%。结论 5年来病原菌的分布排序无明显变化,总体耐药性呈现稳中有降的趋势,但耐药表型的检出率仍处于较高的水平,应引起临床医师和医院感染管理部门的注意。

OBJECTIVE To understand the distribution of common pathogens causing infectious diseases and the change of drug resistance so as to guide the reasonable use of antibiotics,slow down the growth of pathogens and restrain their drug resistance.METHODS Automatic microbial analyzer combined with manual operation was adopted,all the strains isolated from the submitted specimens from 2005 to 2009 were analyzed.RESULTS There were 24353 positive samples which were detected from 93 547 samples with the positive rate of 26.03%;Escherichia coli ranked the first place among the major species of pathogens,the isolation rates from 2005 to 2009 were 17.4%,18.0%,22.0%,20.0% and 23.0%,respectively,presenting an upward tendency;the isolation rates of Pseudomonas aeruginosa from 2005 to 2009 were 13.0%,14.0%,12.7%,13.4% and 14.6%,respectively;the drug resistance rate of E.coli to ampicillin was higher than 80.5%;Staphylococci varied in drug resistance to common antibiotics,the drug resistance rate to penicillin was the highest,reaching up to 98.6%;no strains resistant to vancomycin were detected;the detection rates of ESBLs-producing E.coli and Klebsiella pneumoniae were 47.2% and 27.2%,the detection rate of MRSA was 56.0%.CONCLUSION There is no significant change in the distribution of the pathogens in the past 5 years,the drug resistance decreases under the overall stable status,the detection rate of drug resistant phenotypes maintains a high-level,which should attach great importance of the clinical physician and the department of nosocomial infection management.