2009-2011年医院常见细菌分布及耐药性分析

Distribution and drug resistance of common bacteria from 2009 to 2011

目的调查分析临床分离常见病原菌的耐药变迁,为进一步控制细菌耐药和合理使用抗菌药物提供依据。方法药敏试验采用纸片扩散法,数据分析采用WHONET 5.5软件。结果 3年内临床分离菌株共8064株,以革兰阴性杆菌较多,分别占72.4%、72.8%、82.5%,检出细菌连续3年占前2位的是大肠埃希菌、铜绿假单胞菌,分别为2091、1571株;连续3年产ESBLs大肠埃希菌检出率分别为57.7%、59.1%、56.9%,产ESBLs肺炎克雷伯菌检出率分别为42.7%、41.9%、34.7%,产ESBLs大肠埃希菌和肺炎克雷菌对亚胺培南、哌拉西林/他唑巴坦、阿米卡星的耐药率均<6.0%;铜绿假单胞菌对抗菌药物的耐药率均<40.0%;3年临床分离菌中不动杆菌属分别为112、172、378株,对抗菌药物的耐药率有逐年上升的趋势,特别是对头孢类耐药率均>50.0%;连续3年MRSA占金黄色葡萄球菌的比例分别为57.4%、57.8%、55.7%,MRCNS占凝固酶阴性葡萄球菌比例分别为85.0%、83.7%、82.6%;粪肠球菌对万古霉素、环丙沙星、氨苄西林和呋喃妥因有较好的敏感性,屎肠球菌耐药率较高,对万古霉素和呋喃妥因较敏感。结论 3年除鲍氏不动杆菌的耐药率有上升趋势外,其他细菌的耐药率无明显变化,个别还有下降的趋势,对于鲍氏不动杆菌的发展趋势,应进一步加强监控,遏制鲍氏不动杆菌耐药率进一步上升,防止多药耐药鲍氏不动杆菌在院内传播及泛耐药鲍氏不动杆菌的出现。

OBJECTIVE To investigate the change of drug resistance of the common clinical isolates of pathogens so as to provide basis for the control of bacterial resistance and the reasonable use of antibiotics.METHODS The disc diffusion method was used to perform the drug susceptibility testing,and the statistical analysis was performed by using software WHONET 5.4.RESULTS Totally 8064strains of clinical isolates were isolated within the three years,the gram-negative bacilli were dominant,accounting for 72.4%,72.8%,and 82.5%,respectively;the Escherichia coli（2091strains）and Pseudomonas aeruginosa（1571strains）were the top 2species isolated in the consecutive three years,the detection rates of the ESBLs-producing E.coli were respectively 57.7%,59.1%,and 56.9%in the three consecutive years,while the detection rates of the ESBLs-producing Klebsiella pneumoniae were 42.7%,41.9%,and 34.7%,respectively.The drug resistance rates of the ESBLs-producing E.coli and K.pneumoniae to imipenem,piperacillin/tazobactam,and amikacin were less than 6.0%;the drug resistance rate of the P.aeruginosa was less than 40.0%.There were 112,172,and 378strains of Acinetobacterrespectively isolated in the three consecutive years,the drug resistance rate showed an upward trend,especially more than 50.0% of the drug resistance rate against cephalosporins.The constituent ratios of the MRSA among the Staphylococcus aureus strains were respectively 57.4%,57.8%,and 5.7%in the consecutive three years;the constituent ratios of the MRCNS among the coagulase-negative Staphylococci were 85.0%,83.7%,and 82.6%,respectively.The Enterococcus faecalis strains were highly sensitive to vancomycin,ciprofloxacin,ampicillin,and nitrofurantoin;the Enterococcus feces strains were highly drug resistant,however,they were highly sensitive to vancomycin and nitrofurantoin.CONCLUSIONThe drug resistance rates of the bacterial isolated do not change significantly in the three years except for the increasing drug resistance rate of the A.baumanii,some of the bacteria keep an downward trend of the drug resistant rate.According to the developing trend of the A.baumannii,it is necessary to further strengthen the monitoring,curb the rising drug resistance rate of the A.baumannii,and prevent the spread of multidrug-resistant A.baumannii and the emergence of pandrug-resistant A.baumannii.