2008—2010年血液科临床分离细菌分布及耐药性监测

Distribution and antibiotic resistance of bacterial pathogens isolated during the period from 2008 to 2010 in department of hematology

目的了解山西医科大学第二医院血液科2008—2010年临床分离病原菌的分布特点及其对常用抗菌药物的耐药情况。方法细菌分离按常规方法进行,抗菌药物敏感试验按CLSI 2008年、2009年、2010年版进行并判断结果。结果 943株临床分离菌中,革兰阳性球菌429株,占45.5%,革兰阴性杆菌514株,占54.5%。革兰阳性菌中,凝固酶阴性葡萄球菌(CNS)为血液科分离菌株的第1位。葡萄球菌属细菌中耐甲氧西林金葡菌(MRSA)和耐甲氧西林CNS(MRCNS)检出率分别为17.6%和64.5%,万古霉素对革兰阳性球菌的抗菌活性最强,未发现万古霉素中介金葡菌(VISA)和耐万古霉素金葡菌(VRSA)菌株。屎肠球菌对测试药物的耐药率普遍高于粪肠球菌,未发现对万古霉素、替考拉宁耐药株。革兰阴性菌中,肺炎克雷伯菌为血液科分离菌株的第1位(占12.8%),大肠埃希菌位居第2。亚胺培南对革兰阴性杆菌的抗菌活性最强。鲍曼不动杆菌对亚胺培南和美罗培南耐药率分别为13.2%和11.6%。铜绿假单胞菌对头孢他啶、阿米卡星、环丙沙星耐药率较低,对其他测试抗生素的耐药率均在20%以上,并呈现多重耐药。结论血液病患者易并发医院感染,应引起临床和实验室的高度重视,合理选用抗菌药物是治疗和预防细菌耐药的关键。

Objective To investigate the distribution and antibiotic resistance of bacterial pathogens isolated during the period from 2008 to 2010 in Department of Hematology of Socond Hospital of shanxi Medical University. Methods Clinical isolates were identified and subjected to antimicrobial susceptibility testing by means of a unified protocol. The results were analyzed according to CLSI breakpoints （2008, 2009 and 2010）. Results Of the 943 clinical isolates, gram positive and gram negative organisms accounted for 45.5 % （429/943） and 54.5 %（514/943）, respectively. Coagulase negative Staphylococcus （CNS） was the most frequently isolated gram positive bacteria. The prevalence of methicillin-resistant strains was 17.6% in Staphylococ cus aureus （MRSA）, and 64.5 % in coagulase-negative Staphylococcus （MRCNS）. Vancomycin was the most active antimicrobial agent against gram positive cocci. No VISA or VRSA strain was identified. E. faecium strains were more resistant to most of the antibiotics tested than E. Jaecalis. No enterococeal strain was resistant to vancomycin or teieoplanin. Klebsiella strains were the most frequently isolated gram negative bacteria in Department of Hematology, accounting for 12.8%, followed by E. coli. Imipenem was the most active antibacterial agent tested against gram negative bacilli. About 13.2% and 11.6% of the A. baumannii strains were resistant to imipenem and meropenem, respectively in Department of Hematology. P. aeruginosa showed relatively lower resistance to ceftazidime, amikacin and ciprofloxacin. More than 20% of these P. aeruginosa strains were resistant to other antibiotics. Conclusions Patients with hematological malignancies are susceptible to nosocomial infection, which should be paid more attention to in clinical and laboratory practice. Rational antimicrobial therapy is an effective way for control of antimicrobial resist ance