2002-2011年医院病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing nosocomial infections during 2002-2011

目的分析医院2002-2011年病原菌分布及耐药性,以指导临床抗菌药物合理使用。方法回顾性分析2002-2011年送检样本的病原菌分布及主要病原菌的耐药性;采用法国生物梅里埃公司VITEK-2全自动细菌分析仪及其配套鉴定卡进行菌株鉴定及药敏试验。结果 2002-2011年送检样本呈明显增多趋势,2002-2011年医院感染患者共分离出病原菌24 246株,革兰阴性菌占69.9%,前4位菌依次为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌;革兰阳性菌占25.45%,前4位菌依次为金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、溶血葡萄球菌;真菌占4.65%,以白色假丝酵母菌为主;病原菌主要分离自呼吸道占39.41%～57.24%,其次是创面分泌物占14.51%～22.94%;肺炎克雷伯菌对碳青霉烯类的耐药率10年来一直较低,对头孢哌酮/舒巴坦虽呈上升趋势却不明显,但对氨基糖苷类和喹诺酮类抗菌药物耐药的菌株越来越多,金黄色葡萄球菌10年间未发现耐万古霉素菌株。结论医院病原菌以革兰阴性菌为主,其中主要是肺炎克雷伯菌,其对头孢哌酮/舒巴坦、碳青酶烯类抗菌药物在10年间变化不明显。

OBJECTIVE To analyze the distribution and drug resistance of pathogens that can cause nosocomial infection during 2002-2012,so as to guide the rational use of antibacterial agents.METHODS The distribution of the pathogens and drug resistance of main pathogens sent during 2002-2012were retrospectively analyzed;strain identification and antimicrobial susceptibility test was conducted by BioMerieux VITEK-2full-automatic bacterial analyzer and its associated identification cards.RESULTS The number of samples for test was increased obviously during 2002-2012;a total of 24,246strains of pathogens were isolated from infected patients during the ten years,gram-negative bacteria accounted for 69.9%,and the top four pathogens in order were Klebsiella pneumonia,Escherichia coli,PAE and ABA;gram-positive bacterium accounted for 25.45%,and the top four pathogens in order were Staphylococcus aureus,S.epidermidis,Enterococcus faecalis and S.haemolyticus;fungi accounted for 4.65%,and Candida albicans was the majority.A total of 39.41%-57.24% pathogens were isolated from respiratory tract,followed by secreta（14.51%-22.94%）from wound surface.The drug resistance of K. pneumoniaagainst carbapenems was still low in the ten years,and there were no clear indications of increase in terms of resistance against cefoperazone/sulbactam,while the strains which can resist aminoglycosides and quinolones kept increasing;there were no indications proved that S.aureus could resist vancomycin during the years.CONCLUSIONS The main pathogen detected in hospital is gram-negative bacteria,and K.pneumoniais the majority;its changes in resistance against cefoperazone/sulbactam and carbapenems have no clear indication.