某院近5年痰标本分离病原菌及耐药性分析

Pathogens isolated from sputum specimens and antimicrobial resistance of pathogens in recent 5 years

目的了解某院近5年呼吸科呼吸道感染患者痰标本主要病原菌分布及耐药性变化,为临床感染控制和指导合理用药提供依据。方法常规培养分离细菌,应用VITEK2和Phoenix100全自动细菌鉴定分析仪鉴定菌株;药敏试验采用K-B纸片扩散法,按美国临床实验室标准化协会(CLSI)发布的标准操作。结果 2009—2013年该院呼吸科住院患者痰标本共分离病原菌1 829株,其中革兰阴性杆菌1 442株(78.84%),革兰阳性球菌387株(21.16%)。主要革兰阴性杆菌为鲍曼不动杆菌(21.76%)、铜绿假单胞菌(18.70%)、肺炎克雷伯菌(11.70%)、大肠埃希菌(7.16%);主要革兰阳性球菌为金黄色葡萄球菌和屎肠球菌,分别占11.76%和4.70%。产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌检出率为61.83%和34.45%。鲍曼不动杆菌对阿米卡星、亚胺培南和美罗培南的耐药率均>70%;铜绿假单胞菌对头孢吡肟和头孢他啶的耐药率分别为22.22%和51.46%,对亚胺培南和美罗培南的耐药率分别为49.71%和49.42%。金黄色葡萄球菌中出现了对利奈唑胺耐药的菌株,对呋喃妥因的耐药率<6.0%,5年中耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为88.37%;2013年,肠球菌属对利奈唑胺、替考拉宁的耐药率均为4.35%,对万古霉素的耐药率达8.70%。结论该院呼吸科呼吸道感染患者主要感染病原菌为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和金黄色葡萄球菌,对临床多种常用抗菌药物的耐药率均较高,呈现多药耐药现象。

Objective To understand the distribution and antimicrobial resistance of pathogens from sputum speci-mens of patients with respiratory tract infection in a hospital in recent 5 years,so as to provide basis for infection control and rational use of antimicrobial agents.Methods Bacteria were isolated with routine method,and were i-dentified by VITEK 2 and Phoenix100 automated bacterial identification system,antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method according to the Clinical and Laboratory Standards Institute standards.Results A total of 1 829 pathogenic bacterial strains were isolated from patients in respiratory depart-ment between 2009 and 2013,of which gram-negative bacilli and gram-positive cocci accounted for 78.84% （n=1 442）and 21.16% （n=387）respectively.The major gram-negative bacilli were Acinetobacter baumannii （A.bau-mannii 21.76%）,Pseudomonas aeruginosa （P .aeruginosa 18.70%）,Klebsiella pneumoniae （K.pneumoniae 11.70%）and Escherichia coli （E.coli 7.16%）;the major gram-positive cocci were Staphylococcus aureus （S.au-reus 11.76%）and Enterococcus faecium （E .faecium 4.70%）.The average detection rate of extended-spectrumβ-lactamase （ESBL）-producing E .coli and K .pneumoniae was 61.83% and 34.45% respectively.The resistant rates ofA.baumannii to amikacin,imipenem and meropenem were all ＆gt;70%;the resistant rate of P .aeruginosa to cefepime and ceftazidime was 22.22% and 51.46% respectively,the resistant rate to imipenem and meropenem was 49.71% and 49.42% respectively.Linezolid-resistant S .aureus strains were found,the resistant rate of S .aureus to nitrofurantoin was 〈6.0%,the average detection rate of methicillin-resistant S .aureus （MRSA）was 88.37%;the resistant rates of Enterococcus spp .to linezolid and teicoplanin were both 4.35%,the resistant rate to vancomy-cin was 8.70%.Conclusion The main pathogens causing respiratory tract infection are A.baumannii,P .aerugi-nosa,K .pneumoniae,E.coli and S.aureus ,which have high and multiple resistance to antimicrobial agents.