2013年医院病原菌分布与耐药性分析

Analysis of Pathogenic Bacterial Distribution and Drug Resistance in Our Hospital during 2013

目的了解医院感染病原菌的分布及其耐药性情况,为临床合理用药提供依据。方法对医院2013年所分离病原菌的菌群分布与耐药性进行分析,并用WHONET 5.6软件进行统计。结果共分离出3 016株致病菌,其中以革兰阴性菌为主,大肠埃希菌比例最高（21.44%）、其次是肺炎克雷伯菌（9.63%）、鲍曼不动杆菌（8.88%）;革兰阳性菌中,以金黄色葡萄球菌最高（7.75%）。大肠埃希菌对氨苄西林、第1代头孢类耐药率较高（60%~90%）,对加酶抑制剂β-内酰胺类较敏感,对阿米卡星、亚胺培南完全敏感。肺炎克雷伯菌耐药情况与大肠埃希菌相似,但对氟喹诺酮类耐药率明显低于大肠埃希菌,均低于15%。鲍曼不动杆菌对抗菌药物耐药率均较高,耐药率小于30%的只有有阿米卡星（23.4%）。铜绿假单胞菌对加酶抑制剂类、第4代头孢类、环丙沙星等敏感性较高,对亚胺培南耐药率是17%。葡萄球菌属未出现耐药的抗菌药物有万古霉素、利奈唑胺、呋喃妥因和替加环素。结论医院主要是革兰阴性菌感染,鲍曼不动杆菌耐药性逐渐增强,故应加强细菌耐药性监测,合理使用抗菌药物。

Objective To investigate the pathogenic bacterial distribution and their drug resistance in our hospital to provide the basis for clinical rational drug use. Methods The flora distribution of isolated pathogenic bacteria during 2013 and their drug resistance were statistically analyzed by WHONET 5. 6 software. Results Among 3 016 isolated strains of pathogenic bacteria,the Gram- negative bacteria were predominant,Escherichia coli had the highest proportion（ 21. 44%）,followed by Klebsiella pneumoniae（ 9. 63%） and Bauman Acinetobacter（ 8. 88%）; Staphylococcus aureus had the highest proportion（ 7. 75%） in Gram- positive bacteria. Escherichia coli had higher resistance rate to ampicillin and first generation cephalosporins（ 60%- 90%）,which was more sensitive to the β- lactam inhibitor and fully sensitive to amikacin and imipenem. The drug resistance of Klebsiella pneumoniae was similar to that of Escherichia coli,but its resistance rate to fluoroquinolone was significantly lower than that of Escherichia coli and less than 15%. The resistance rate of Acinetobacter baumannii to antimicrobial drugs was higher, but only which to amikacin was less than 30%（ 23. 4%）. Pseudomonas aeruginosa was highly sensitive to enzyme inhibitors, fourth generation cephalosporins and ciprofloxacin, the resistance rate to imipenem was 17%. Antibiotics without appearing resistant Staphylococcus were vancomycin, linezolid, nitrofurantoin and tigecycline. Conclusion Gram- negative bacteria are still main pathogenic bacteria in our hospital,the drug resistance of Bauman Acinetobacter is gradually increased. So the bacterial drug resistance monitoring should be strengthened and antimicrobial agents should be rationally used.