2011年江苏盛泽医院病原菌分布及耐药性监测

Surveillance of pathogen distribution and resistance from Jiangsu Shengze Hospital in 2011

目的:了解江苏盛泽医院2011年各科室培养阳性标本病原菌分布和耐药性规律。方法:收集培养标本共2 224例,利用API系统进行细菌及真菌鉴定采用,细菌药物敏感性测定采用纸片扩散法;WHONET5.5软件进行数据分析。结果:检出阳性标本648例,阳性率为29.1%;阳性标本主要分布在神经内科(26.7%),呼吸内科(23.8%),重症监护病房(17.6%)等;检出革兰氏阳性菌128株,占19.8%;革兰氏阴性菌431株,占66.5%;真菌89株,占13.7%;其中检出率最高的病原菌是大肠埃希菌,占阳性标本的16.4%,其次是铜绿假单胞菌(16.0%)和肺炎克雷伯菌(13.6%);耐药性分析结果显示,肠杆菌科细菌中大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(extended spectrumβlactamases,ESBLs)的检出率分别为67.0%、62.5%;产ESBLs菌株对常用抗菌药物的耐药率高于非产ESBLs菌株,肠杆菌科细菌对碳青霉烯类抗菌药物高度敏感(94.0%～100.0%);非发酵菌属对抗菌药物的耐药率均显著高于肠杆菌科细菌;葡萄球菌属中甲氧西林耐药株对抗菌药物的耐药性显著高于甲氧西林敏感株,且未发现万古霉素和替考拉宁的耐药株;肠球菌和链球菌对青霉素和红霉素耐药率较高,均在65%以上,未发现对万古霉素和替考拉宁耐药的菌株。结论:本院常见病原菌的耐药情况较为严重,进行细菌耐药性监测有助于了解病原菌耐药性的变迁指导临床应合理使用抗菌药物,减缓新耐药株的产生。

Objective：To determine the pathogen distribution and resistance pattern of the positive clinical specimens in Jiangsu Shengze Hospital in 2011.Methods：A total of 2 224 samples were collected from this hospital in 2011.Bacteria and fungus were identified by API systems,bacterial drug sensitivity was determined by disk diffusion method,WHONET5.5 software was used for data analysis.Results：The positive rate was 29.1%（648/2 224）of 2 224 culture specimens.The majority of the positive specimens were from nerve internal division（26.7%）,respiratory division（23.8%）,intensive care unit（17.6%） and so on.The percentage of Gram positive bacteria were19.8%（128/648）,Gram negative bacteria 66.5%（431/648） and fungus 13.7%（89/648）.The most freguent pathogen was Escherichia coli,accounting for 16.4%,the next was Pseudomonas aeruginosa（16.0%） as well as Klebsiella pneumoniae（13.6%）.In view of the resistance,extended spectrum β lactamases（ESBLs） were produced in 67.0% of E.coli and 62.5% of Klebsiella pneumoniae.The resistant rates of ESBLs producing strains were higher than those non-ESBLs-producing strains,Enterobacteria were highly sensitive to carbapenem（94.0%～100.0%）.The resistant rates of non-fermentative Gram negative strains were higher than Enterobacteriaceae strains.Resistance rates of methicillin resistant strains were higher than methicillin sensitive strains,and no resistant strains to vancomycin and teicoplanin were reported.The resistance rate of Enterococcus and Streptococcus to penicillin and erythromycin were higher（〉 65%）,no strain was found to resistant to vancomycin and teicoplanin Conclusion：Antimicrobial resistance in clinical bacterial isolates was a very serious problem in our hospital.Surveillance of bacterial resistance was important and valuable for understanding the change of pathogenic bacteria and drug resistance.The reasonable antibiotics should be applied to prevent the occurrence of resistant strains.