医源性多药耐药菌感染的动态及耐药性分析

Analysis of dynamic condition and drug resistance of iatrogenic multidrug resistant bacteria infections

目的了解医院多药耐药现状及病原菌耐药性,为预防与控制医院感染提供必要的病原学依据。方法 2012年9月-2013年5月临床住院患者送检的1517份各类标本,采用法国生物梅里埃公司VITEK-32全自动细菌分析系统进行细菌鉴定,药敏试验使用K-B纸片扩散法,以WHONET5.4软件分析数据。结果共分离出1 132株病原菌,标本来源以痰液、分泌物、脓液为主,分别占40.92%、16.40%、12.52%;共检出多药耐药菌567株,其中产ESBLs大肠埃希菌378株占66.67%;产ESBLs克雷伯菌属96株占16.93%;产ESBLs大肠埃希菌对氨苄西林、头孢曲松、头孢呋辛、头孢唑林、哌拉西林耐药率均>97.62%,产ESBLs克雷伯菌属对头孢呋辛、氨苄西林/舒巴坦、阿莫西林/克拉维酸、氨曲南耐药率均为100.00%,耐甲氧西林金黄色葡萄球菌对苯唑西林、头孢唑林、头孢呋辛、环丙沙星、红霉素具有较高的耐药性,多药耐药铜绿假单胞菌、鲍氏不动杆菌对多种抗菌药物显著耐药,而对亚胺培南、美罗培南敏感。结论多药耐药菌医院感染现象日趋严重,应加强病原菌检测和耐药性监测,依据药敏试验结果选用抗菌药物,从而降低医院感染率。

OBJECTIVE To investigate the multi-drug resistance situation and drug resistance of pathogenic bacteria in hospital so as to provide requisite aetiology basis for the prevention and control of nosocomial infections. METI-IODS The various types of 1 517 specimens were collected from the hospitalized patients from Sept. 2012 to May 2013 ; the bacterial identification was conducted with VITEK-32 automatic micro-bacteria verification analyzer produced by BioMerieux, the drug susceptibility test was carried out by Kirby-Bauer method, the statistical analysis of drug resistance was performed by suing WHONET 5.4 software. RESULTS A total of 1139, strains of pathogenic bacteria were isolated, including 567 strains of multidrug resistance bacteria, the top three included 378 strains of ESBLs producing Escherichia coli （66. 67%） and 99 strains of ESBLs producing Klebsiella spp （16.93%）. They were mainly from sputum（40. 92%）, secretions（16.40%）, and pus（12.52~）. The resistant rate of ESBLs producing E, coli to ampicillin, ceftriaxone cefuroxime, cefazolin, piperacillin was all 〉97.62%, and the resistant rate of ESBLs producing Klebsiella spp to cefuroxime, ampicillin/sulbactam, amoxicillin/ clavulanic Acid, and aztreonam was all 100. 00%. The drug resistance of MRSA was higher to oxacillin, cefazolin, eefuroxime, ciprofloxaein, erythromycin. Multi-drug resistant Pseudomonas aeruginosa, Acinetobacter baumannii were notably resistant to various antibiotics, but two strains were sensitive to imipenem and meropenem. CONCLUSION The nosocomial infections state oi multidrug resistance strains are increasingly serious, thus it is necessary to strengthen the detection of pathogenic bacteria and the monitoring of drug resistance and select antibiotics according to the result of drug sensitive test to reduce the rate of nosocomial infections.