基层医院常见病原菌耐药性监测分析

Monitoring of drug resistance of common bacteria in grass-roots hospitals

目的探讨基层医院常见病原菌的耐药性，为各社区门诊和临床合理用药提供可靠的科学依据。方法对2010—2011年医院及下属的8个社区服务站送检的各类标本分离出的病原菌，采用VITEK-2全自动微生物分析仪进行鉴定及药敏试验，部分药敏采用K—B法，依照美国临床实验室标准化研究所（CLSI）2011年制定的标准判断结果，采用WHONET5．6和SPSS13．0软件对数据进行统计分析。结果共收集2010-2011年送检的各类标本分离出的非重复菌4907株，革兰阳性菌727株占14．8％，革兰阴性菌3495株占71．2％，真菌685株占14．0％；未检出耐万古霉素和替考拉宁葡萄球菌；肠杆菌科细菌对碳青霉烯类抗菌药物和哌拉西林／他唑巴坦保持高度敏感性，耐药率仅为0．5%～5．5％，铜绿假单胞菌对碳青霉烯类、氨基糖苷类和喹诺酮类耐药率均有不同程度下降。结论医院常见病原菌的耐药性呈下降趋势，医院定期对细菌耐药监测情况进行分析，临床据监测结果合理使用抗菌药物，有效的延缓细菌耐药性产生。

OBJECTIVE To explore the drug resistance of common bacteria in grass-roots hospitals so as to provide reliable basis for the rational use of antibiotics in community clinics. METHODS There were bacteria cultured from specimens of hospitals and 8 communities from 2010 to 2011, VITEK-2 system analyzer was used to identify the isolates, the drug susceptibility testing was carried out,by K-B method, the results were interpreted by referring to the standards formulated by the CLSI, and the data were statistically analyzed with the use of WHONET5; 6 and SPSS13.0. RESULTS A total of 4907 strains of non-repetitive bacteria were isolated from the submitted specimens from 2010 to 2011, among which there were 727 （14. 8%） strains of gram-positive bacteria% 3495 （71.2 % ） strains of gram-negative bacteria, and 685 （14. 0 %） strains of fungi, no vancomycinor teicoplaninresistant Staphylococcus were found. The Enterobacteriaceae remained high susceptibility against carbapenems and piperacillin-tazobactam, with the drug resistance rates ranging between 0.5 % and 5.5 % ; the drug resistance rates of Pseudornonas aeruginosa to carbapenems, aminoglycosides and quinolones declined in varying degrees, CONCLUSION The drug resistance of the common pathogens shows a downward trend; the regular monitoring of the bacterial resistance and reasonable use of antibiotics in accordance with the monitoring result can effectively inhibit the bacterial resistance.