医院住院患者主要感染病原菌的临床分布与耐药情况分析

Analysis on clinical distribution and drug resistance of the main pathogenic bacteria from nosocomial infection inpatients

目的：了解住院患者医院感染情况、菌群分布及耐药现状，为医院感染的控制和指导临床合理用药提供可靠的依据。方法对我院2013年1～8月住院患者送检标本分离所得1625株阳性菌株的菌群分布情况、耐药特点进行回顾性分析。结果在分离所得阳性菌株中，革兰阴性菌构成比明显高于革兰阳性菌，分离率依次为大肠埃希菌（16.4%），金黄色葡萄球菌（12.9%），铜绿假单胞菌（12.5%），肠杆菌属（9.9%），克雷伯菌属（6.8%）。根据标本来源分析，伤口分泌物分离率最高的是金黄色葡萄球菌（17%），痰液分离率最高的是铜绿假单胞菌（24.8%），中段尿和血液分离率最高的是大肠埃希菌（分别为45.8%和23.9%）。临床分布中， ICU病区以革兰阴性菌为主；金黄色葡萄球菌主要来自于骨伤科病区（占51.6%）；在各内科病区，革兰阴性菌和革兰阳性菌的构成比差别不大，在30%左右。耐药情况分析，三种主要G＋球菌对万古霉素和利奈唑胺-的敏感率均＞95%；四种主要的G杆菌对美罗培南和亚胺培南的敏感性较好，敏感率为73%～100%；在非发酵菌中，铜绿假单胞菌对大部分抗菌药物仍保持一定的抗菌活性；而不动杆菌属已表现出多重耐药。结论病原菌在不同标本来源、不同临床病区的菌群分布具有各自的特点，与患者感染发生的部位、医源性操作行为有关；及时监测病原菌变化及耐药趋势，针对不同病原菌的耐药情况，合理选择抗生素，以减少多重耐药菌株的产生和发展。

Objective To understand the nosocomial infection status, flora distribution and drug resistance of inpatients, in order to provide the reliable basis for the clinical control of nosocomial infection and guidance of the clinical rational drug use. Methods The flora distribution and drug resistance characteristic of 1625 positive strains isolated from the specimens of inpatients in our hospital during January 2013 to Augest 2013 were retrospectively analyzed. Results In the isolated positive strains, the proportion of gram-negative bacteria was significantly higher than that of gram-postive bacteria, the isolation rate in turn were Escherichia coli（16.4%）, Staphylococcus aureus（12.9%）, pseudomonas aeruginosa（12.5%）, Enterobacter spp（9.9%）,Klebsiella pneumonia（6.8%）.According to the specimen source, the S.aureus strains were mainly isolated from the wound specimens（17.0%）; the isolated rate of sputum in pseudomonas aeruginosa was highest（24.8%）; Escherichia coli had the highest isolated rate in the middle piece urine and blood（respectively 45.8% and 23.9%）.In the clinical distrubion, the ICU dominated by gram-negative bacteria, Staphylococcus aureus came mainly from the orthopedic ward（51.6%）; In the inernal medicine ward, the proportion of gram-negative bacteria and gram-postive bacteria were similar, which accounted for about 30%. The analysis of drug resistance showed that the sensitive rate of the three main gram-postive aureus to Vancomycin and Linezolid were more than 95.0%; the sensitive rate of the four major gram-negative bacilli to Meropenem and Imipenem were better and 73%-100%;In the non-fermentative bacteria, the pseudomonas aeruginosa to most antibiotics still maintained a certain antibacterial activity, but acinetobacter had multiple drug resistance. Conclusion Pathogenic bacteria has its own characteristics in different specimen source and different flora distribution from different clinical ward, and is associated with the parts of the infection and the iatrogenic operation behavior; Monitoring the change and drug resistance of pathogens in time, selecting the antibiotics reasonably for drug resistance of different pathogenic bacteria can reduce the emergence and development of multiple drug resistant strains.