细菌耐药监测与医院感染控制

Surveillance of bacterial resistance and control of nosocomial infections

目的了解临床分离病原菌对常用抗菌药物耐药性,指导临床有效的控制医院感染。方法用纸片扩散法(K-B)进行药物敏感试验,判定标准按CLSI 2009年版规定。结果收集947株临床分离病原菌,其中革兰阴性菌占78.7%、革兰阳性菌占21.3%;常见病原菌依次为铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌;大肠埃希菌和肺炎克雷伯菌对第三代头孢菌素、头孢吡肟、氨曲南的耐药率分别在16.7%～49.1%和18.6%～44.1%;对碳青霉烯类抗菌药物仍高度敏感,但耐药菌也已出现;鲍氏不动杆菌耐亚胺培南和美罗培南菌株占>60.0%,耐亚胺培南和美罗培南铜绿假单胞菌分别为42.7%和50.3%,非发酵菌对多黏菌素E敏感性较好;金黄色葡萄球菌和表皮葡萄球菌对万古霉素仍高度敏感。结论细菌多耐药现象严重,尤其耐三代头孢菌素的肠杆菌科细菌和对碳青霉烯类抗菌药物耐药的非发酵菌增多,必须加强耐药菌监测,并采取有效的控制措施。

OBJECTIVE To investigate the antibacterial resistance of clinical isolates to commonly used antibiotics so as to provide scientific base for the prevention and control of nosocomial infections. METHODS The antimicrobial susceptibility was tested by Kirby Bauer （K-B） and the results were analyzed according to the standards recom- mended by CISI 2009. RESULTS A total of 947 strains of pathogens were isolated, among which the gram-positive cocci accounted for 21.3 % and the gram-negative bacilli accounted for 78.7 %. Pseudomonas aeruginosa, Acineto- bacter baumannii , Staphylococcus aureus , Klebsiella pneumoniae , and Escherichia coli were the predominant spe- cies of pathogens; the resistance rates of E. coli and K. pneumoniae to the third generation cephalosporins, eefepime and aztreonam respectively varied from 16. 7% to 49. 1%and from 18. 6% and 44. 1%; the strains remained highly sensitive to the carbapenems, but the drug resistant stains have emerged. The A. baumannii strains resistant to imipenem or metropenem accounted for more than 60.0%, the imipenem-resistant P. aerugino- sa and the meropenem-resistant P. aeruginosa accounted for 42.7 % and 50.3 %, respectively, the non-fermenting bacteria were highly sensitive to polymyxin E; S. aureus and S. epidermidis remained highly sensitive to vaneomy- cin. CONCLUSION The strains are seriously multidrug-resistant, especially to the third generation cephalosporin- resistant Enterobacteriaceae, and the non-fermenting bacteria resistant to the carbapenems are increased, thus it is necessary to strengthen the monitoring of drug resistant bacteria and take effective control measures.