2011年临床常见病原菌分布特点及耐药性分析

Distribution and antibiotics resistance of clinical common pathogenic bacteria in 2011

目的回顾性分析临床分离常见病原菌分布及对常用抗生素耐药情况,为临床合理用药提供依据。方法对2011年1～12月临床送检各类标本进行分离培养,采用全自动微生物仪进行菌株鉴定,抗菌药物的敏感性检测采用K-B纸片扩散法,判定标准依据CLSI2009指南判定。结果共分离出病原菌2 790株,以革兰阴性杆菌为主,前四位依次为克雷伯菌属、大肠埃希菌、铜绿假单胞菌和不动杆菌。肠杆菌科细菌对氨苄西林耐药率最高,均大于76.3%,对阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦保持较高的敏感性,耐药率小于25.9%,大肠埃希菌产超广谱β-内酰胺酶(ESBLs)检出率为52.3%;克雷伯菌属产ESBLS检出率为33.9%。ESBLs的大肠埃希菌和克雷伯菌属对抗菌药物的耐药率明显高于非产ESBLS的菌株,未检出耐亚胺培南、美罗培南菌株。非发酵菌中,阿米卡星、头孢哌酮/舒巴坦、美洛培南对铜绿假单胞菌具有良好的抗菌活性;亚胺培南、美洛培南、米诺环素对不动杆菌属敏感性强。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为44.1%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率为69.8%,耐甲氧西林的葡萄球菌对所有β-内酰胺类抗生素均耐药,未检出耐万古霉素和利奈唑胺的葡萄球菌。结论及时准确地对本地区病原菌进行耐药性监测,为临床合理应用抗生素提供有力的依据,预防和延缓耐药菌的产生和传播。

Objective To investigate the distribution of clinical common pathogenic bacteria in our hospital and their antibiotics resist- ance, and provide reference for reasonable choices of the clinical antibiotics. Methods All kinds of samples from Jan to Dec 2011 in our hospital were cultured. The identification of bacteria and antibiotics susceptibility test were performed by using VITEK2 - compact automatic biology analy- sis and Kirby - Bauer method. The criterion of judgement were consistent with CLSI2009 handbook. Results 2 790 strains of pathogenic bacteria were isolated. Gram - negative bacilli were in the majority. The common organisms were Klebsiella, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. Enterobacteriaceae bacteria had highest resistance against ampicillin accounting for more than 76.3% ,and had higher sus- ceptibility to amikacin, piperacillin/tazobactam and cefoperazone/sulbactam The antibiotics resistance was less then25.9%. The ESBLs isolating rate was 52.3% in E. coli and 33.9% in Klebsiella. The antibiotics resistance were obviously high in those ESBLs producing strains. No enter- obacteriaceae bacteria which are resistant to imipenem or meropenem were isoIated. Among non - fermentative bacteria, amikacin, cefoperazone/ sulbactam and meropenem had better antibacterial activity to pseudomonas aeruginosa. Acinetobacter had higher susceptibility to imipenem, mero- penem and minocycline. The isolating rate of MRSA and MRCNS was 44.1% and 69.8% in staphylococcus. MRS are resistant to all betalactam antibiotic. No staphylococcus which are resistant to vancomycin or teicoplanin were isoIated. Conclusion We should monitor pathogenic bacteria in our regions timely and exactly, and to provide reference for reasonable choices of the clinical antibiotics These methods can reduce antibiotics - resistance bacteria or delay its development.