眼科医院感染病原菌的耐药性监测

Monitoring of antimicrobial resistance of pathogens causing nosocomial infections in ophthalmic hospital

目的 了解眼科医院病原菌流行情况，提高医院感染管理水平，为眼科医师用药提供依据。方法对2011年6月一2012年6月871例各种眼外伤或眼部炎症的样本及其医院环境的标本进行病原菌培养和种属鉴定，对主要的条件致病菌进行耐药性分析，对产ESBLs菌采用PCR技术进行耐药基因检测。结果共检出病原菌147株，其中革兰阳性菌最多为85株占57.8%，主要革兰阳性菌为表皮葡萄球菌、金黄色葡萄球菌，分别占25. 2%、4.1%;革兰阴性菌46株占31.3%，检出1株产TEM型和CTX-M型的ESBLs细菌；真菌16株占10. 9%;主要的医院感染病原菌对一线代表性的抗菌药物头孢类、氨基_苷类、喹诺酮类等药物均保持66. 0%-84. 0%药物敏感率，对万古霉素保持敏感率接近100. 0%。结论眼科医院存在耐药菌感染的风险，但通过加强病原菌监测、合理使用抗菌药物、实行严格的医院感染管理制度能控制眼科医院感染。

OBJECTIVE To investigate the distribution and prevalence of pathogens in eye hospital and enhance themanagement level of nosocomial infections, and instruct rational use of drugs by ophthalmologists. METHODS Weperformed culture of pathogens and species identification of the 871 samples isolated from eye trauma, inflammation and environment in hospital during the period from Jun 2011 to Jun 2012 , and conducted analysis on the anti-microbial resistance of major conditioned pathogens. Drug-resistant genes were detected by PCR technique in ex-tended-spectrum-lactamases （ESBLs）-producing bacteria. RESULTS Totally 147 pathogens were detected, ofwhich there were 85 strains of gram-positive bacteria（57. 8%）,the Staphylococcus epidermidis and Staphylococcus aureus were the main species, accounting for 25. 2% , and 4. 1 %, respectively; there were 39 strains of gram-negative bacteria（26. 5%） , including one TEM and CTX-M gene-type ESBLs-producing bacteria; there were 16strains of fungi（10. 9%） ; 66. 0%-84. 0% of the major conditioned pathogens were sensitive to the first-line repre-sentative drugs of cephalosporins, aminoglycosides, and quinolones,and the drug susceptibility rate to vancomycinwas nearly up to 100. 0%. CONCLUSION The infection risk of antimicrobial resistance bacteria exists in the eyehospitals,but it can be reduced through enhancement of monitoring of pathogens,rational use of antibiotics, andstrict nosocomial infection management.