医院病原菌临床分布及耐药性分析

Clinical distribution and drug resistance of pathogens

目的了解2011年医院分离病原菌临床分布及其对常用抗菌药物的耐药性,为临床合理选用抗菌药物提供依据。方法采用回顾性调查方法,对送检标本同时接种巧克力平板和血平板,24h培养出菌落后进行分离培养、鉴定和药敏试验;使用WHONET 5.4软件对药敏结果进行耐药性分析。结果 46 657份标本中共分离出病原菌10 450株,阳性率为22.40%;其中革兰阴性杆菌5447株占52.12%,革兰阳性球菌2202株占21.07%,真菌1699株占16.26%,其他病原菌1102株占0.55%;肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感,耐药率<4.00%,对氨苄西林耐药率高达>89.00%;葡萄球菌属对青霉素耐药率>95.00%,但对万古霉素、利奈唑胺、呋喃妥因敏感;葡萄球菌属中耐甲氧西林金黄色葡萄球菌(MRSA)分离率较高,占83.10%;肠球菌属中粪肠球菌对多数测试药物的耐药率低于屎肠球菌,两者中均有少数万古霉素耐药株,未发现利奈唑胺耐药株。结论临床分离的病原菌以革兰阴性菌为主,革兰阳性菌中耐甲氧西林葡萄球菌所占比例较高,真菌感染亦占一定比例,分离菌株的耐药现象普遍存在,临床应根据药敏结果合理选择抗菌药物,以减少病原菌耐药的发生。

OBJECTIVE To investigate the clinical distribution of the pathogens isolated from the hospital in 2011 and analyze the drug resistance to commonly used antibiotics so as to provide basis for the reasonable clinical use of antibiotics. METHODS By means of the retrospective survey, the submitted specimens were inoculated into the chocolate tablet and blood agar plate, the bacterial colonies were cultured for 24 hours, then the bacterial strains were isolated and identified, the drug susceptibility testing was performed. The drug susceptibility testing results were analyzed by using WHONET 5.4. RESULTS A total of 10 450 strains of pathogens including 5447（52.12% ） strains of gram-negative bacilli, 2202 （21.07% ） strains of gram-positive cocci, 1699 （16.26% ） strains of fungi, and 1102（10.55%） strains of other species were isolated from 46 657 clinical specimens with the detection rate of 22.40%. The Enterobacteriaceae strains were still highly susceptible to the carbapenem antibiotics, with the resistance rate being less than 4.00% ,more than 89.00% of the drug resistance rate against ampicillin. The drug resistance rate of Staphylococcus spp to penicillin was more than 95.00%, but which were sensitive to vancomycin and linezolid. Among Staphylococcus spp strains, isolation rate of methicillin-resistant Staphylococcus aureus was 83.10%. Among the Enterococci strains, Enterococcus faecalis strains were with lower drug resistance rate to most of the test antibiotics than the Enterococcus feces strains, there were few strains of vancomycin-resistant E. faecalis or E. feces, and no strains of linezolid-resistant strains were found. CONCLUSION The gram-negative bacteria are the main clinical isolates of pathogens ,and the methicillin-resistant Staphylococci strains, as well as the fungi, take a large proportion among the gram-positive cocci. It is prevalent that all the clinical isolates are drug resistant, thus it is necessary to reasonably use antibiotics on the basis of drug susceptibility testing result so as to reduce the drug resistant strains.