神经外科鲍曼不动杆菌、铜绿假单胞菌及金黄色葡萄球菌的分布及耐药性分析

Distribution and drug resistance analysis of baumanii,pseudomonas aeruginosa,staphylococcus aureus in neurosurgery

目的分析该院神经外科鲍曼不动杆菌、铜绿假单胞菌及金黄色葡萄球菌的分布和耐药特征。方法对该院2006-2011年神经外科送检标本进行培养分离病原菌,并应用全自动细菌鉴定分析仪鉴定菌种,药敏试验采用K-B纸片法和琼脂平板稀释法,按CLSI规定的标准进行。耐甲氧西林金黄色葡萄球菌的确定以头孢西丁纸片法制定。结果共分离鲍曼不动杆菌252株、铜绿假单胞菌530株、金黄色葡萄球菌514株,主要分布于呼吸系统和中枢神经系统。鲍曼不动杆菌对头孢他啶(CAZ)和哌拉西林/他唑巴坦(TZP)的耐药率分别为87.3%和71.4%,对亚胺培南(IPM)和美罗培南(MPM)的耐药率分别为32.1%和37.2%。而铜绿假单胞菌对IPM和MPM的耐药率为50.9%和41.3%。耐甲氧西林金黄色葡萄球菌(MRSA)的分离率为89.9%,金黄色葡萄球菌对左氧氟沙星(LEV)和利福平(RD)的耐药率为89.1%和78.5%,未发现对万古霉素(VA)、替考拉宁(TEC)和利奈唑胺(LNZ)耐药的金黄色葡萄球菌。结论神经外科临床分离的鲍曼不动杆菌、铜绿假单胞菌及金黄色葡萄球菌耐药现象较为普遍,且耐药率呈逐年上升的趋势,应动态监测神经外科院内感染常见病原菌的流行和耐药状况。临床应在经验性用药同时进行病原学检查,根据药敏结果适当调整抗菌药物,以逐步降低细菌耐药状况,避免院内感染和暴发流行。

Objective To analysis the distribution and drug resistance of banmanii, pseudomonas aeruginosa, staphy- lococcus aureus in neurosurgery. Methods Isolation and culture the specimens from 2006 -201t in neurusurgery, identified pathogens by fully automatic bacterial identification analyzer, susceptibility testing was determined by K-B disk method and Agar dilution method, strictly in accordance with the standards prescribed by the CLSI. Methicillin-resistant staphylococcus was determined by cefoxitin disk diffusion. Results There were 252 strains of baumanii,530 strains of pseudomonas aeruginosa, 514 strains of staphylococcus aureus in neurosurgery,which mainly distributed in the respiratory and central nervous system. The resistance rates of baumanii on ceftazidime（CAE） was 87.3. The resistance rates of baumanii on piperacillin/tazobactam （TEP） was 71.4%. The resistance rates of baumanii on imipenem（IPM） was 32.1%. The resistance rates of baumanii on meropenem（MPM） was 37.2%. The resistance rates of pseudomonas aeruginosa on IPM was 50.9%. The resistance rates of pseudomonas aeruginosa on MPM was 41.3%. The isolation rate of methicillin-resistant staphylococcus aureus （MRSA） was 89.9%. The resistance rates of staphylococcus aureus on levofloxacin （LEV） was 89.1%. The resistance rates of staphylococ- cus aureus on rifampicin（RD） was 78.5%. There were no tolerance of staphylococcus aureus on vancomycin（VA） ,teicoplanin （TEC） ,linezolid（LNE）. Conclusion The phenomenon of resistance about baumanii,pseudomonas aeruginosa,staphylococ- ens aurens separated in neurosurgery is prevalent, and the resistance rates increased year by year. The Common Pathogens Pop- ular and drug resistance of noso comial infections in neurosurgical should be dynamic monitoring. Clinical empirical medication should be conducted while pathogenic examination. To adjust the antimicrobial agents based on the susceptibility results in or- der to reduce the drug rdsistance and avoid the nosocomial infection and out break.