2012年四川省人民医院临床分离病原菌的分布及耐药分析

Analysis of distribution and drug resistance of clinical isolated pathogenic bacteria in Sichuan Provincial Hospital during 2012

目的了解我院临床分离病原菌的分布特点及耐药情况，为临床合理选用抗菌药物提供依据。方法收集2012年1～12月我院临床标本中分离的病原菌，采用VITEK2-compact全自动细菌分析仪进行鉴定和药敏试验。按美国临床和实验室标准协会（ClinicalandLaboratoryStandardsInstitute，CLSI）2012年版标准判断结果，应用WHONET5．6软件进行统计和分析。结果2012年我院共分离病原菌4902株，其中革兰阴性菌3731株（占76．2％），革兰阳性菌1171株（占23．8％）。排列前三位革兰阳性球菌为金黄色葡萄球菌582株（11．9％）、屎肠球234株（4．8％）和凝固酶阴性葡萄球菌202株（4．1％）；排列前三位革兰阴性杆菌为‘大肠埃希菌927株（18．9％）、肺炎克雷伯菌622株（12．7％）和鲍曼不动杆菌511株（10．4），以呼吸道、尿路、血液感染为主。其中耐甲氧西林金黄色葡萄球菌（MRSA）检出率为30．2％，耐甲氧西林葡萄球菌（MRSCN）检出率为86．5％，MRSA对氨基糖苷类、喹诺酮类抗菌药呈多重耐药，耐药率均〉90．0％，而对大环内酯类抗菌药耐药率〈50．O％；未发现耐万古霉素和利奈唑胺的葡萄球菌；屎肠球菌对万古霉素和利奈唑胺的耐药率分别为5．7％和1．8％。产ESBLs大肠埃希菌及肺炎克雷伯菌的检出率分别为56．3％和30．9％，大肠埃希菌及肺炎克雷伯菌对亚胺培南的耐药率分别为0．1％和1．5％；鲍曼不动杆菌对常用抗菌药物的耐药率达50．0％以上，铜绿假单胞菌对常用的有抗假单胞菌活性的药物的耐药率小于30．0％。结论2012年我院分离病原菌耐药现象较为普遍，开展细菌耐药性监测，对指导临床合理使用抗生素，降低医院感染率和控制细菌耐药性有重要意义。

Objective To investigate the distribution and drug resistance to commonly used antibiotics of clinical isolates ob- tained from Sichuan Provincial People＇s Hospital. Methods The bacteria strains isolated from clinics were collected. Identification and drug susceptibility test were performed by VITEK2-compact automatic analysis system and the results were analyzed according to the standard published by the Clinical and Laboratory Standards Institute （CLSI） using WHONET5.6 software. Results A total of 4902 bacterial isolates including 3731 （76. 2% ） gram-negative strains and 1171 （23.8%） gram-positive strains were obtained. The top three populations of gram-positive strains were S. aureus （582 isolates, 11.9% ）, E. faecium （234 isolates,4. 8% ） and Coagulase neg- ative Staphylococcus （202 isolates,4. 1% ）. The top three populations of gram-negative bacterial were E. coli （927 isolates, 18.9% ）, K. pneumoniae （622 isolates, 12. 7% ） and A. baumannii （511 isolates, 10. 4% ）. The detection rates of methicillin-resistant Staphylo- coccus aureus （MRSA） and coagulase-negative Staphylococcus （MRSCN） were 30. 2% and 86. 5%, respectively. No vacomycin-re- sistant Staphylococcus strains were found. The resistance rates of Enterococcus faecium and Enterococcus faecalis to vancomycin were 5.7% and 1.8% ,respectively. No linezolid-resistant Enterococcus was found. The resistance rates to imipenem of E. coli and K. Pneu- moniae isolates were 0. 1% and 1.5%, respectively. The resistance rate of Pseudomonas aeruginosa to carbapenems was more than 50%, while the drug resistance of A. baumannii was higher than that of P. aeruginosa. Conclusion Drug resistance of bacterial isolated from our hospital is a common phenomenon. Therefore, we should carry out the surveillance of bacterial resistance. This will be very im- portant for rational use of drug, reduction of rate of hospital infection and control of bacterial drug resistance.