7852株临床分离病原菌株的分布特点及耐药性分析

Distribution and drug resistance of 7852 clinical isolated pathogenic bacterial strains

目的了解临床分离病原菌株的分布情况及主要病原菌的耐药特点。方法回顾性分析海南省人民医院2013年1~12月份分离出的7 852株病原菌,用DL-96微生物鉴定及药敏分析系统对分离菌进行鉴定和药敏分析,并对其分布特点和耐药性进行统计分析。结果 2013年共收集到非重复临床分离菌7 852株,其中革兰阴性菌65.9%（5 176/7 852）,革兰阳性菌20.5%株（1 613/7 852）,真菌13.5%（1 062/7 852）。构成比排名前5名的病原菌依次为铜绿假单胞菌（14.2%）、大肠埃希菌（13.0%）、肺炎克雷伯菌（8.3%）、鲍曼不动杆菌（7.0%）、金黄色葡萄球菌（6.8%）。凝固酶阴性葡萄球菌和耐甲氧西林金黄色葡萄球菌（MRSA）分别占4.3%和27.1%,革兰阳性菌对万古霉素均敏感,对利奈唑胺、替考拉宁敏感率较高,肠杆菌科细菌对亚胺培南和美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星敏感性较高。大肠埃希菌、肺炎克雷伯菌ESBLs的检出率分别为40.4%、24.3%,ESBLs阳性菌株对大多数抗菌药物的耐药率高于非产ESBLs阴性的菌株。非发酵菌仅对粘菌素、多粘菌素B敏感性较高。鲍曼不动杆菌耐药率高于铜绿假单胞菌。结论临床分离的病原菌种类较多,且耐药性较高,及时监测病原菌变化及耐药趋势,提高临床标本送检率,指导临床合理使用抗生素至关重要。

Objective To investigate the distribution and drug resistance of main clinical pathogenic bacterial strains.Methods The 7 852 bacterial strains collected from Hainan People＇s Hospital in 2013 were retrospectively analyzed andidentified by DL-96.Drug sensitivity of these isolates was also performed. Results Totally 7 852 non- replicated strainswere collected,65.9%（5 176/7 852）of them were gram-negative,20.5%（1 613/7 852）were gram-positive and 13.5%（1 062/7 852）were fungi. The top five pathogens in proportion were Pseudomonas aeruginosa（14.2 %）,Escherichia coli（13.0%）,Klebsiella pneumoniae（8.3 %）,Acinetobacter baumannii（7.0%）and Staphylococcus aureus（6.8%）. Proportions ofcoagulase-negative Staphylococci and MRSA were 4.3% and 27.1% respectively. Gram-positive bacteria were all sensitive tovancomycin and the resistance rates were relatively high to linezolid and teicoplanin. Enterobacteria were relatively sensitiveto to imipenem and meropenem,piperacillin / tazobactam,cefoperazone / sulbactam,amikacin. The positive rates of ESBLs-producing Escherichia coli and Klebsiella pneumoniae were 40.4% and 24.3%,respectively.The resistance rate of ESBLs-producing strains was higher than that of non-ESBLs-producing strains to most antimicrobial drugs. The non-fermentativebacteria were only sensitive to colistin and polymyxin B.The drug resistance rate of Acinetobacter baumannii was higher thanthat of Pseudomonas aeruginosa.Conclusions There are many kinds of clinical isolates,and their drug resistance rates wererelatively high. Thus it is important to monitor the mutation and drug resistance of pathogens and improve the rational drug use.