2011-2013年住院患者脑脊液病原菌的耐药性监测

Drug resistance of pathogens isolated from cerebrospinal fluid of hospitalized patients in 2011-2013

目的了解脑脊液分离病原菌的流行病学及耐药性,为临床治疗及医院感染控制提供依据。方法对2011-2013年临床送检脑脊液标本进行分离培养,检测对常用抗菌药物的敏感性,应用WHONET5.5软件进行统计,χ2检验采用SPSS17.0软件进行统计分析。结果 2011-2013年共检出病原菌225株,其中革兰阳性菌129株占57.33%,革兰阴性菌75株占33.34%,真菌21株占9.34%,主要革兰阳性菌为表皮葡萄球菌和人葡萄球菌,分别占24.44%和5.78%,主要革兰阴性菌为鲍氏不动杆菌和嗜麦芽寡养单胞菌,分别占16.89%和4.89%;表皮葡萄球菌对青霉素G、氨苄西林的耐药率较高,>82.0%,对喹奴普汀/达福普汀、利福平、左氧氟沙星较敏感,耐药率<20.0%,鲍氏不动杆菌对替卡西林/克拉维酸、头孢他啶、头孢噻肟的耐药率>66.0%,对头孢哌酮/舒巴坦的耐药率较低,为16.7%;目标性监测菌中,多药耐药菌分离率为37.09%,每千住院日新发生率为0.004‰。结论革兰阳性菌为脑脊液主要致病菌,鲍氏不动杆菌分离率在革兰阴性菌中居首位,脑脊液分离病原菌耐药性低于2011年全国监测数据,应多部门联合做好预防控制工作。

OBJECTIVE To understand the epidemiological characteristics and drug resistance of the bacteria isolated from cerebrospinal fluid so as to provide guidance for clinical treatment and control of nosocomia[ infections. METHODS From 2011 through 2013, the submitted cerebrospinal fluid specimens were cultured, then the drug susceptibility to the commonly used antibiotics was determined, the statistical analysis was performed with the use of WHONETS. 5 software, and the chi-square test was conducted by using SPSS17.0 software. RESULTS A total of 225 strains of pathogens have been isolated from 2011 to 2013, including 129 （57.33 %）strains of gram-positive bacteria, 75 （33.33%） strains of gram-negative bacteria, and 21 （9.34%） strains of fungi. The Staphylococcus epidermidis and Staphylococcus hominins were the predominant species of gram-positive bacteria, accounting for 24.44% and 5.78 %, respectively; the Acinetobacter baumannii and Stenotrophomonas maltophilia were domi- nant among the gram-negative bacteria, accounting for 16.89% and 4.89%, respectively. The drug resistance rates of the S. epidermidis to penicillin G and ampicillin were more than 82.0%, while the drug resistance rates to quinupristin-dalfopristin, rifampin, and levofloxacin were less than 20.0%. The drug resistance rates of the A. baumannii to ticarcillin-clavulanic acid, ceftazidime, and cefotaxime were more than 66.0 %, and the drug resist- ance rate to cefoperazone-sulbactam was 16.7 %. Among the bacteria under targeted monitoring, the isolation rate of multidrug-resistant bacteria was 37.09 % the incidence rate of infections per one thousand hospitalization day was0. 004‰. CONCLUSION The gram-positive bacteria are the predominant pathogens isolated from the cerebro-spinal fluid; the A. baumannii ranks the first place of the isolated gram-negative bacteria. The drug resistance rate of the bacteria isolated from the cerebrospinal fluid basically lower than that from the national surveillance data in 2011. Multiple departments should work together for the prevention and control.