四川省人民医院老年科病原菌分布及耐药性监测结果分析

Surveillance of bacterial resistance in geriatrics department of Sichuan Provincial People's Hospital during 2010

目的了解四川省人民医院老年科临床病原菌分布及其耐药性。方法采用VITEK-2 compact全自动微生物分析仪对四川省人民医院老年科住院患者病原菌进行鉴定和药敏试验,按CLSI 2009年版判断结果。结果 2110株细菌中革兰阴性菌占82.7%,革兰阳性菌占17.3%。分离前五位是铜绿假单胞菌、大肠埃希氏菌、肺炎克雷伯氏菌、不动杆菌及肠杆菌属;葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为50.3%和61.5%;发现一株耐万古霉素的屎肠球菌(VRE),同时也对替考拉宁耐药。肠杆菌科细菌对亚胺培南均高度敏感(>98%)。鲍曼不动杆菌对亚胺培南的敏感率为39.6%,对铜绿假单胞菌耐药率最低的是阿米卡星为5.3%;不动杆菌属耐药率均在50.0%以上。大肠埃希菌和肺炎克雷伯菌中产超广谱β-酰胺酶(ESBLs)菌株的阳性率分别为51.0%和34.0%。结论老年患者感染以呼吸道感染为主,耐药状况严重,但肠杆菌科细菌对碳青霉烯类抗菌药物敏感度高。加强细菌耐药性监测,为临床合理应用抗菌药物提供科学依据。

Objective To investigate the antibiotic resistance of clinical isolates collected in geriatrics department of Sichuan Provincial People＇s Hospital from January to December in 2010. Methods VITEK-2 compact microbial analysis systems were performed to identify 2110 clinical isolates and analyze the antibacterial activities according to CLSI 2009. Results Gram-positive microorganisms and gram-negative microorganisms accounted for 17.3% and 82.7% , respectively. The detection rates of methicillin-resistant Staphylococcus （MRSA） and coagulase-negative Staphylococcus （CNS） in Staphylococci were 50.3 % and 61.5 %. There was one strain of E. faecium resistant to vancomycin and teicoplanin. About 51.0% of E. eoli and 34.0% of Klebsiella pneumoniae were ESBLs-produeing strains. The sensitive rate of imipenem against Aeinetobacter baumannii was 39.6% ,while amikacin against pseudomonas aerug inosa was relative to the lowest drug-resistant rate of 5.3 %. Conclusions The geriatric infection was dominated by respiratory system infection,and the situation of drug resistance was serious. Enterobacteriaceae still has a high sensitivity to carbapenems. Hospital should strengthen the surveillance of bacterial resistance, and provide the scientific basis for rational use of antibiotics.