教学医院临床病原菌分布及耐药性变化趋势

Distribution and variation of antimicrobial resistance of pathogenic bacteria isolated from clinical specimens in a teaching hospital

目的探讨教学医院临床分离病原菌分布及其耐药性,指导临床抗菌药物经验治疗。方法收集2006-2010年医院细菌室分离的细菌,采用全自动微生物分析仪VITEK-2Compact进行细菌鉴定,药敏试验采用K-B法,使用WHONET5.5软件进行数据的统计分析。结果 5年共分离病原菌15 334株,其中革兰阴性菌10 641株占69.4%;革兰阳性菌4693株占30.6%;前3位病原菌分别是大肠埃希菌占21.3%、凝固酶阴性葡萄球菌占12.7%和克雷伯菌属占11.7%;血培养共分离病原菌1137株,前3位分别是大肠埃希菌、表皮葡萄球菌和肺炎克雷伯菌;尿培养前3位为大肠埃希菌、粪肠球菌和屎肠球菌,而静脉导管培养共检出病原菌113株;MRSA5年检出率为30.9%～61.7%,差异有统计学意义(P<0.01),未发现耐万古霉素和替考拉宁菌株;5年共检出耐万古霉素肠球菌20株,有逐年增加趋势;肠杆菌科细菌对三、四代头孢菌素耐药率高达78.0%,且逐年增高,对亚胺培南、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦仍高度敏感,但耐药率均有逐年增加趋势;铜绿假单胞菌和鲍氏不动杆菌对亚胺培南的耐药率在19.8%～51.4%,鲍氏不动杆菌对亚胺培南和头孢哌酮/舒巴坦耐药率有逐年增加趋势,差异均有统计学意义(P<0.01),且对多数抗菌药物耐药率也逐年增加。结论初步建立了医院细菌流行及其耐药监测基础数据平台,较为全面了解医院病原菌耐药现状,细菌耐药现象较为严重,尤其是多药耐药非发酵菌十分普遍。

OBJECTIVE To explore the species of the pathogens isolated form clinical specimens in a teaching hospital and their drug resistance so as to guide the empirical treatment. METHODS The bacteria isolated from the clinical specimens from 2006 to 2010 were collected, the identification of the isolated strains was performed with the automatic microorganism analyzer VITEK-2 Compact, the drug susceptibility testing was conducted by K-B method, statistical analysis of the data was performed by WHONET5.5 software. RESULTS A total of 15 334 strains of pathogens were isolated during the past 5 years, including 10 641 （69.4%） strains of gram-negative bacteria and 4693 （30.6%） strains of gram-positive bacteria; Escherichia coli （21.3%）, Klebsiella pneurnoniae （11.7%） and coagulose-riegative Staphylococci （12.7%） ranked the top 3 species; of 1137 strains of pathogens isolated from the blood culture, E. coli,S, epidermis and K. pneumoniae were the top 3 pathogens; E. coli, Enterococcus faecalis, and E. feces were the top 3 pathogens cultured from urine, there were totally 113 strains of pathogens cultured from venous catheter; the detection rates of MRSA isolated during the 5 years varied from 30.9% to 61.7%, the difference was statistically significant （P〈0.01）, no vancomycin-resistant or teicoplanin- resistant strains were found; totally 20 strains of vancomycin-resistant Enterococci were isolated during the 5 years, with an increasing tendency; the drug resistance rates of Enterobacteriaceae to the third and fourth generation of cephalosporins reached up to 78.0% and increased year by year, Enterobacteriaceae remained highly susceptible to imipenem, piperacillin/tazolbactam and cefoperzone/sulbactam, the drug resistance rates increased year by year;the drug resistance rates of Pseudornnas aeruginosa and Acinetobacter baurnannii to imipenem varied from 19. 8% to 51. 4%, the drug resistance rates of A; baurnannii to imipenem and cefoperazone/sulbactamincreased year by year, the difference was statistically significant （P〈0O. 01）, and the drug resistance rates to most of antibiotics increased as well. CONCLUSION The basic data platform of the surveillance for the spread of bacteria and the drug resistance has been established to comprehensively understand the current status of drug resistance of the pathogens, the drug resistance of the pathogens, multidrug-resistant non-fermenting bacteria, is very prevalent.