某院2012年多重耐药菌分布及耐药性

Distribution and antimicrobial resistance of multidrug-resistant organisms in a hospital in 2012

目的调查某院2012年多重耐药菌(MDROs)的临床分布及耐药性,为防控MDROs感染提供理论依据。方法采用目标性监测方法对该院2012年1—12月检出的MDROs的分布及药敏结果进行分析。结果共检出MDROs 370株,其中革兰阴性(G-)杆菌341株(92.16%),革兰阳性(G+)球菌29株[7.84%,均为耐甲氧西林金黄色葡萄球菌(MRSA)];临床分离MDROs前5位的科室分别为重症监护室(79株)、神经外科(65株)、神经内科(40株)、普通外科(39株)、老年科(32株)。29株MRSA对复方磺胺甲口恶唑、替加环素、利福平等抗生素耐药率均>60%,无万古霉素耐药株;产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌对亚胺培南的敏感率>75%,对头孢哌酮/舒巴坦、阿米卡星的敏感率在50%左右;多重耐药的铜绿假单胞菌和鲍曼不动杆菌对抗菌药物普遍不敏感,特别是多重耐药的鲍曼不动杆菌,几乎是泛耐药。结论该院分离的MDROs以G-菌为主,主要分离自收治重症及高龄患者的科室。需加强医院感染监测和采取有效的感染控制措施,以防MDROs播散。

Objective To investigate clinical distribution and antimicrobial resistance of multidrug resistant organ isms（MDROs）in a hospital in 2012,and provide reference for the prevention of MDROs infection.Methods Distri bution and antimicrobial susceptibility testing results of MDROs isolated from patients in a hospital between January and December 2012 were analyzed by targeted monitoring method.Results A total of 370 MDROs strains were isolated,isolation rate of gram-negative bacilli and gram-positive cocci was 92.16％ （n =341） and 7.84％ （n =29,all were methicillin-resistant Staphylococcus aureus [MRSA]）respectively; the top five departments with high MDROs isolation rates were intensive care unit（n =79 isolates）,department of neurosurgery （n =65）,neurology （n =40）general surgery（n =39）,and geriatrics（n =32）.Resistant rates of 29 MRSA strains to compound sulfamethoxazole,tigecycline,and rifampicin were all＞60％,no vancomycin-resistant strain was detected; resistant rates of extended spectrum beta-lactamase （ESBLs）-producing Escherichia coli and Klebsiella pneumoniae to imipenem were ＞75 ％,resistant rates to cefoperazone / sulbactam and amikacin were about 50％; multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii were generally not sensitive to antimicrobial agents,multidrug-resistant Acinetobacter baumannii were almost pandrug-resistant strains.Conclusion The major MDROs isolated from this hospital are gram negative bacteria,strains are mainly from patients with severe diseases and elderly age.Monitor and control measures on healthcare-associated infection should be intensified to prevent the spread of MDROs.