临床常见病原菌分布及耐药性分析

Distribution and drug resistance of common pathogens in hospital

目的调查分析医院临床常见病原菌的分布及耐药性,以指导临床合理使用抗菌药物。方法对2011年1-12月住院患者采集的血液、尿液、大便、各类分泌物等标本按《全国临床检验操作规程》(第3版)要求培养并做菌株鉴定和药敏试验。结果共检出病原菌264株,其中革兰阳性菌69株占26.1%,革兰阴性菌153株占58.0%,真菌42株占15.9%;革兰阴性菌以铜绿假单胞菌、大肠埃希菌为主,分别占19.3%、12.1%,铜绿假单胞菌对克林霉素、头孢曲松、氨芐西林的耐药率分别为100.0%、92.2%、92.2%;大肠埃希菌对环丙沙星、克林霉素、哌拉西林、氨芐西林的耐药率分别为51.6%、93.8%、79.7%、82.8%;其中革兰阴性菌鲍氏不动杆菌对氨苄西林、第一、二代等头孢菌素天然耐药并具有多药耐药性,革兰阳性菌以金黄色葡萄球菌为主,对克林霉素、阿奇霉素、哌拉西林高度耐药。结论应加强对铜绿假单胞菌、大肠埃希菌、鲍氏不动杆菌的耐药性监测,合理使用抗菌药物,遏制细菌耐药性的进一步蔓延。

OBJECTIVE To mvesugate the hospital so as to guide the reasonable use of antibiotics. METHODS The clinical samples such as blood, urine, stool, and all kinds of secretions were collected from the hospitalized patients from Jan to Dec 2011, then the bacterial ident%（ication and the drug susceptibility testing were performed according to the Nationa% Clinical Labo- ratory Procedures （third edition）. RESULTS A total of 264 pathogenic bacteria were detected , among which there were 69 strains ofgram-pOsitive bacteria （26.1 %）, 153 strains of gram-negative bacteria （58.0%） and 42 strains of fungi （15- 9 %）. Among the gram-negative bacteria, the Pseudomonas aeruginosa and Escherichia coli were the predominant species, accounting for 19.3 % and 12.15, respectively. The drug resistance rates o{ P. aeruginosa to clindamycin, ceftriaxone, and ampicillin were 100. 0%/00, 92. 2%, and 92. 2%, respectively, and the drug resistance rates of E. coli to ciprofloxacin, clindamycin, piperacillin, and ampicillin were 51. 6%, 93. 8%, 79.7%, and 82.8%, respectively. Among the gram-negative bacteria, the A. baumannii strains were naturally resistant and multidrug-resistant to ampicillin, the first-generation, and sec0nd-generation of cephalosporins; the Staphylococcus aureus was the predominant gram-positive bacteria and were highly resistant to clindamycin, azithromydn, and piperacillin. CONCLUSION It is necessary to strengthen the monitoring o{ drug resistance of P. aeruginosa, E. coli, and A. baumannii, and the reasonable use of antibiotics can further curb the spread of bacterial resistance