医院病原菌分布及耐药性监测分析

Distribution and drug resistance of pathogens

目的通过监测住院患者病原菌分布及耐药特征,及时掌握医院耐药菌监测情况,以指导临床合理应用抗菌药物。方法采用回顾性调查方法对医院2012年1-3月临床各科送检的标本进行检测,用美国德灵公司的MicroScanAutoScan-40半自动微生物鉴定仪和药敏系统及配套NC21测试板和Positive Combo Pane Type11同时进行菌株鉴定与药物敏感性测定;并检测ESBLs菌及MRS,采用WHONET 5软件进行统计分析。结果共分离出580株病原菌,以革兰阴性杆菌为主,占68.3%,产ESBLs大肠埃希菌占55.2%、产ESBLs肺炎克雷伯菌占40.5%、MRSA占40.0%、MRCNS占76.4%;大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对亚胺培南、哌拉西林/他唑巴坦、阿米卡星的耐药率均<20.0%,鲍氏不动杆菌对多数抗菌药物耐药率均>60.0%,耐药率<10.0%的只有亚胺培南,MRSA及MRCNS均为多药耐药菌,仅对呋喃妥因和万古霉素较敏感。结论医院应及时监测细菌耐药性情况,临床应重视病原菌检查及根据药敏合理选择应用抗菌药物,以减少病原菌耐药的发生。

OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from the hospitalized patients and understand the status of surveillance of the drug resistance so as to provide guidance for reasonable clinical use of antibiotics. METHODS By means of retrospective survey, the specimens that were obtained from different clinical departments from Jan to Mar 2013 were detected, then the identification of strains was conducted by MicroScanAutoScan-40 semiautomatic microorganism identification system of Dade Behring, USA, the drug susceptibility was determined with drug susceptibility system including its matched NC21 test plate and Positive Combo Pane Type 11 , the extended spectrumji-Iactamase （ESBLs ）-producing strains and the methicillin-resistant Staphylococcus （MRS） were detected, and the statistical analysis was performed with WHONET 5 software. RESULTS A total of 580 strains have been isolated, among which the gram-negative bacilli were dominant, accounting for 68. 3 % in clucling; the ESBLs-producing Escherichia coli strains 55. 2 % and the ESBLsproducing Klebsiella pneumoniae 40.5%, the methicillin-resistant Staphylococcus aureus （MRSA） 40. 0 %, the methicillin-resistant coagulase-negative Staphylococcus （MRCNS） 76.4%; The drug resistance rates of the E. coli, K. pneumoniae , and Pseudomonas aeruginosa to imipenem , piperacillin-tazobactam, and amikacin were less than 20. 0 %; the Acinetobacter baumannii strains were highly drug-resistant, the drug resistance rates to most of the test antibiotics were more than 60.0 %, and the drug resistance rate to imipenem was less than 10. 0 %; The MRSA and MRCNS were the multidrug-resistant strains and were only susceptible to nitrofurantoin and vancomycin. CONCLUSION It is necessary for the hospital to monitor the bacterial drug resistance, focus on the detection of pathogens, and reasonably use antibiotics according to the result of drug susceptibility testing so as to reduce the drug resistance.