感染性疾病的病原菌分布及耐药性监测分析

Distribution and drug resistance of pathogens isolated from minority areas

目的研究感染性疾病的病原菌构成,分析细菌感染种类和耐药性,为临床合理使用抗菌药物提供科学依据。方法收集临夏州人民医院、临夏州中医医院及临夏市民族医院2009-2011年微生物检验标本进行细菌培养及药敏试验,细菌培养和鉴定严格按照《全国临床检验操作规程》进行,药敏试验采用CLSI推荐方法。结果 8100份标本中共分离出病原菌3820株,总阳性率为47.2%,其中革兰阴性菌2190株占57.33%;革兰阳性菌1140株占29.84%;真菌490株占12.83%;感染性疾病主要由肠杆菌科、葡萄球菌属、非发酵菌属、肠球菌属及假丝酵母菌属感染导致;产特殊耐药酶细菌所占比率分别为产ESBLs大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌分别为56.4%、49.8%、52.8%;革兰阳性球菌中MRSA、MRCNS、VRE分别为54.2%、61.3%、0,未检出VRSA;利奈唑胺、万古霉素、替考拉宁对革兰阳性球菌始终保持高敏感性,亚胺培南、美罗培南对革兰阴性杆菌有很高的敏感性,产ESBLs的大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌分别为56.4%、49.8%、52.8%。结论应高度重视细菌培养和药敏试验,加强病原菌耐药性监测,及时掌握细菌耐药规律,定期发布病原菌构成及耐药规律和信息,指导医师合理使用抗菌药物,减少或延缓耐药菌株产生,尤其是多药耐药菌的产生和传播。

OBJECTIVE To study the distribution of the pathogens causing infectious diseases in minority areas andanalyze the species of pathogens and the drug resistance so as to provide scientific basis for the reasonable clinicaluse of antibiotics. METHODS The microbiological testing specimens were collected from People＇s Hospital ofLinxia, Linxia Chinese Medicine Hospital, and Linxia City National Hospital between 2009 and 2011,then thebacterial culture and identification were carried out in strict accordance with the National Clinical Laboratory Procedures, and the drug susceptibility testing was performed by using the method recommended by CLSI. RESULTSOf 8100 clinical specimens, totally 3820 strains of pathogens were isolated with the total positive rate of 47. 2%,including 2190 （57. 33%） strains of gram-negative bacteria,1140 （29. 84%） strains of grampositive bacteria,and490 （12.83%） strains of fungi. The Enterobacteriaceae,Staphylococcus,non-fermenting bacteria,Enterococci,and Candida were the main species of pathogens causing the infectious diseases in the areas. Among the gram-positive cocci, the MRSA, MRCNS, and VRE accounted for 54. 2% , 61. 3% , and 0,respectively, while the VRSAstrains have not been detected. The gram-positive cocci remained high susceptibility to linezolid, vancomycin,andteicoplanin, while the gram-negative bacilli were highly sensitive to imipenem and meropenem; the ESBLs-producing Escherichia coli,Klebsiella pneumonia , and Enterobacter cloacae accounted for 56. 4%,49. 8%, and52. 8%,respectively. CONCLUSION It is necessary to focus on the bacterial culture and drug susceptibility testing, strengthen the monitoring of drug resistance,understand the rules of bacterial resistance, issue the information of the distribution of pathogens or the.drug resistance regularly, guide the reasonable use of antibiotics so asto prevent the drug-resistant strains from emerging, especially the emergence and spread of multidrug-resistantbacteria.