医院常见病原菌的分布及耐药性变迁

Distribution and drug resistance change of common pathogenic bacteria in hospital

目的了解医院常见病原菌的构成比及耐药趋势,为指导临床合理用药及控制感染提供依据。方法对2012-2014年临床送检的各类标本中分离的病原菌及耐药性进行回顾性分析。结果 2012-2014年共分离菌株1 325株,革兰阴性菌889株占67.10%,革兰阳性菌284株占21.43%,真菌152株占11.47%。分离前五位的菌株依次是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌和鲍氏不动杆菌,大肠埃希菌和肺炎克雷伯菌对亚胺培南高度敏感,耐药率小于3.7%,但均检出碳青霉烯类耐药株（CRE）,铜绿假单胞菌对美罗培南耐药率上升,对亚胺培南耐药率下降,鲍氏不动杆菌对亚胺培南和美罗培南耐药率大于44.83%,金黄色葡萄球菌的甲氧西林耐药株（MRSA）检出率由69.05%下降至的54.05%,屎肠球菌对万古霉素、利奈唑胺、替考拉宁、呋喃妥因高度敏感,但出现万古霉素耐药株（VRE）菌株。结论医院常见病原菌的耐药性严重,应加强细菌耐药性监测,合理使用抗菌药物,采取有效的感控措施,预防和减少耐药菌株的产生。

Objective To understand the constituent ratio and the drug resistance tendency of the common pathogens in hospital in order to provide the basis for rational clinical drug use and control of nosocomial infection .Methods The pathogenic bacteria iso‐lated from the various submitted clinical specimens and their drug resistance in our hospital from January 2012 to December 2014 were performed the retrospective analysis .Results A total of 1 325 strains of pathogenic bacteria were isolated ,among them 889 strains （67 .10% ） were Gram‐negative cocci ,284 strains（21 .43% ） were Gram‐positive cocci and 152 strains （11 .47% ） were fun‐gi .The top five of isolated strains were Escherichia coli ,Klebsiella pneumonia ,Pseudomonas aeruginos ,Staphyloccocus aureus and Acinetobacter baumannii .Escherichia coli and Klebsiella pneumonia were highly resistant to imipenem with the resistance rate of 3 .7% ,but carbapenems‐resistant strain（CRE） was detected out .The resistant rateof Pseudomonas aeruginos to meropenem was in‐creased and which to imipenem was decreased .The resistant rates of Acinetobacter baumannii to meropenem and imipenem were o‐ver 44 .83% .The detection rate of methicillin‐resistant Staphylococcus aureus （MRSA ） was decreased from 69 .05% to 54 .05% . Enterococcus faecium was highly sensitive to vancomycin ,linezolid ,teicoplanin and furadantin .But vacomycin‐resistant strains （VRE） were found .Conclusion The drug resistance of common pathogens causing nosocomial infection is serious in our hospital . Therefore ,it is very important to strengthen the monitoring of bacterial drug resistance ,rationally use antimicrobial drugs and adopt the effective measure of infection control to prevent and reduce the generation of drug‐resistant pathogens .