从临床标本中分离出的病原性细菌的分布及耐药性分析

Distribution and antibiotic resistance of pathogenic bacteria isolated from clinical sample

目的了解中南大学湘雅医院2012年临床分离病原菌分布及耐药性变迁,为临床合理使用抗菌药物提供依据。方法采用全自动微生物鉴定及药敏系统对临床标本分离的病原性细菌进行鉴定及药敏试验,所有实验数据用WHONET 5.6软件进行分析。结果该院2012年共分离非重复病原菌7 227株,结果显示革兰阴性菌占63.7%(4 607/7 227),革兰阳性菌占36.3%(2 620/7 227)。革兰阴性菌中分离最多的依次为大肠埃希菌(20.2%)、肺炎克雷伯菌(17.6%)以及鲍曼不动杆菌(16.7%);革兰阳性菌以凝固酶阴性葡萄球菌(30.3%)以及金黄色葡萄球菌(26.1%)的分离为最多。大肠埃希菌和肺炎克雷伯菌ESBLs检出率分别为69.8%和48.6%,肠杆菌科细菌对亚胺培南的耐药率低于4.0%。金黄色葡萄球菌(SA)和凝固酶阴性葡萄球菌(CNS)中耐甲氧西林菌株的检出率分别为45.1%和80.7%,未检出对万古霉素和利奈唑胺耐药株;MRSA中对复方新诺明的敏感率为78.8%,MRCNS中对利福平的敏感率为79.3%。粪肠球菌对所测试抗菌药物的敏感性均显著高于屎肠球菌,两者对万古霉素的耐药率分别为0.9%和1.0%,并均检出少量对VA中介的菌株。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为35.9%和68.6%,发现多株泛耐药非发酵菌。结论临床分离病原菌仍以革兰氏阴性杆菌为主,细菌耐药现象十分严重;耐甲氧西林葡萄球菌及产ESBLs的大肠埃希菌和肺炎克雷伯菌的分离率高,泛耐药非发酵革兰阴性杆菌有增加趋势;应加强细菌耐药监测,指导临床合理使用抗菌药物。

[ Objective ] To investigate the distribution and antibiotic resistance of clinical isolates from Xiangya Hospital of Central South University in 2012, and provide criteria for selection and application of antibiotics in clinics. [ Methods] Identification of isolates and antimicrobial susceptibility test were carried out by automatic microorganism clinical analytical system. The data were analyzed by WHONET 5.6 software. [ Results ] A total of 7,227 isolates were collected in 2012, 63.7% （4,607/7,227） of which were gram-negative bacteria, and 36.3% （2,620/7,227） of which were gram-positive bacteria. Among the gram-negative bacteria, Escherichia coli （20.2%）, Klebsiella pneu- monia （17.6%）, and Acinetobacter baumannii （16.7%） were the most common isolates. Among the gram-positive bacteria, Coagulase-negative Staphylococci （30.3%） and Staphylococcus aureus （26.1%） were the most common iso- lates. The detective rate of extended-spectrum beta-lactamase （ESBL） in Escherichia coli and Klebsiella pneumoni- ae were 69.8% and 48.6% respectively. Less than 4.0% of E.coli were resistant to Imipenem. Tile detective rates of methieillin were 45.1% and 80.7% in Staphylococcus aureus and Coagulase-negative Staphylococci respectively. No Vaneomycin or Linezolid-resistant strains were detected. There were 78.8% of the MRSA （methicillin-resistant Staphylococcus aureus） isolates sensitive to Trimethoprim-sulfamethoxazole, and 79.3% of the MRCNS （methicillinresistant Coagulase-negative Staphylococci） isolates sensitive to Rifampicin. Enterococcus faecalis were more sensitive to the antibiotics than Enterococcus feces. The Vancomycin resistant rates were 0.9% and 1.0% for Enterococcus faecalis and Enterococcus feces respectively, and a few of the isolates were intermediate to Vancomycin. The Imipenem-resistant rates were 35.9% and 68.6% for Pseudomonas aeruginosa and Acinetobacter baumannii respectively, and a few pan-resistant Enterobacteriaceae had been detected. [ Conclusions ] The majority of the clinical isolates from the hospital were gram-negative bacilli. Antibiotic resistance of clinical isolates is widespread.The separation rate of MRCNS is as high as the ESBLs which detected in Escherichia coli and Klebsiella pneumoniae. Pandrug resistant non-fermenting gram-negative bacteria is increasing. We should strengthen antibiotic resistance surveillance and instruct the rational use of antibiotics.