外科感染患者细菌分布及耐药性的单中心研究

Surveillance of bacterial distribution and drug resistance in inpatients with surgical infections： a single center study

目的 分析外科感染患者细菌分布及其对常用抗菌药物的耐药性,为外科感染的规范化治疗提供依据.方法 回顾性调查分析2008年1月至201 1年12月外科感染患者送检标本的细菌鉴定及药物敏感性检测结果.结果 3257份临床标本共分离菌株3829株,革兰阴性杆菌占62.4％（以大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌为主）;革兰阳性球菌占37.6％（以肠球菌、金黄色葡萄球菌及凝固酶阴性葡萄球菌为主）,其中金黄色葡萄球菌、粪肠球菌检出率呈升高趋势.大肠埃希菌及肺炎克雷伯菌对亚胺培南、阿米卡星、哌拉西林/他唑巴坦等抗菌药物耐药率较低;铜绿假单胞菌和鲍曼不动杆菌对头孢类、碳青霉烯类及喹诺酮类抗菌药物耐药率较高,呈多药耐药性;所有葡萄球菌、粪肠球菌对万古霉素和替考拉宁敏感（100％）,但耐万古霉素屎肠球菌检出率呈上升趋势（1.9％～7.5％）.产超广谱β-内酰胺酶（ESBL）大肠埃希菌检出率为45.6％ ～61.5％;产ESBL肺炎克雷伯菌检出率呈波动表现;耐甲氧西林金黄色葡萄球菌检出率较高（21.1％ ～55.8％）,耐甲氧西林表皮葡萄球菌检出率明显高于其他阳性球菌.结论 我院外科临床感染病原菌以革兰阴性杆菌为主,临床分离细菌耐药现象较为普遍,铜绿假单胞菌和鲍曼不动杆菌药物耐药率较高.

Objective To investigate the bacterial distribution and drug resistance in patients with surgical infections, and provide the basis for the standardization treatment of the surgical infection. Methods Retrospectively analyzed from January 2008 to December 2011 surgical infection in our samples bacteria identification and drug sensitivity test results. Results A total of 3829 nonduplicate isolates from 3257 samples, Gram-negative bacteria accounted for 62.4% （the main microbes were P. aeruginosa, K. pneumonia and E. coli etc ） and Gram-positive bacteria accounted for 37.6% （ the main microbes were Enterococcus, Staphylococcus and coagulase negative Staphylococcus）. Incidence of Staphylococcus aureus and Enterococcusfaecalis were on an obvious increase. For the performance of the high level of sensitive to Imipenem, Amikacin, Piperacillin and Tazobactam by E. coli and K. pneumonia. The Pseudomonas aeruginosa and Acinetobacter baumannii to cephalosporins, Carbapenems and Fluoroqinolones were higher resistant with Multidrug resistance. No vancomycin and teicoplanin resistant Enterococcus faecium were found. The prevalence of ESBL E. coli was 45.6%-61.5% and ESBL K. pneumoniae isolates were fluctuated. The methicillin-resistant S. aureus （MRSA） isolates were relatively high （21.1%-55.8% ） , and methicillin-resistant Staphylococcus epidermidis was higher than the other Gram-positive cocci. Vancomycin for Staphylococcus performance was highly sensitive. Conclusions The main composition of surgical clinical infection pathogens are Gram-negative bacillus, and the emergency of resistance of bacteria to antibacterial drugs is a common phenomenon. The resistant rate shows ascendant trend; Drug resistance is significantly higher in Pseudomonas aeruginosa and Acinetobacter baumannii. Antimicrobial resistance is a serious and challenging issue.