医院感染阴沟肠杆菌的分布与耐药性分析

Distribution and drug resistance of Enterobacter cloacae causing nosocomial infections

目的分析2009-2013年医院住院患者感染阴沟肠杆菌的临床分布特点及其耐药性,指导临床合理用药。方法收集2009年1月1日-2013年12月31日医院不同病区住院患者送检标本中分离出的阴沟肠杆菌386株,其分离严格按照《全国临床检验操作规程》进行,细菌鉴定采用法国生物梅里埃公司的VITEK-2Compact细菌鉴定仪,采用CLSI推荐的纸片扩散法进行药敏试验,数据采用Whonet5.4软件进行分析。结果 386株阴沟肠杆菌主要分离自痰液、尿液、伤口,分别占49.5%、13.7%、9.1%;高干病房、手外科、中心ICU、感染科和胸外科分离的阴沟肠杆菌最多,分别占14.8%、7.8%、7.5%、7.5%和7.3%;阴沟肠杆菌对哌拉西林、头孢噻肟、头孢他啶、磺胺甲噁唑/甲氧苄啶耐药率分别为52.1%、57.3%、42.5%、34.7%。结论阴沟肠杆菌主要引起呼吸道、尿路与伤口感染,阴沟肠杆菌耐药率高,应合理使用抗菌药物,控制阴沟肠杆菌引起的医院感染。

OBJECTIVE To observe the clinical distribution and drug resistance of Enterobacter cloacae causing infections in the patients who were hospitalized Huashan Hospital from 2009 to 2013 so as to guide reasonable clinical use of antibiotics .METHODS A total of 386 strains of E .cloacae were collected from the submitted speci‐mens that were obtained from the patients who were hospitalized in different wards from Jan 1 ,2009 to Dec 31 , 2013;the strains were isolated in strict accordance with National Clinical Laboratory Procedures ,the bacterial identification was conducted by using VITEK‐2 Compact bacterial identification system of BioMerieux ,France , the drug susceptibility testing was performed with the use of disk diffusion method recommended by CLSI ,and the data were analyzed by using Whonet 5 .4 software .RESULTS Of the 386 strains of E .cloacae ,49 .5% were isola‐ted from the sputum ,13 .7% from the urine ,9 .1% from the wound .As for the distribution of the E .cloacae iso‐lates ,14 .8% were from the cadre ward ,7 .8% from the hand surgery department ,7 .5% from the central ICU , 7 .5% from the infection control department ,7 .3% from the thoracic surgery department .The drug resistance rates of the E .cloacae isolates to piperacillin ,cefotaxime ,ceftazidime ,and sulfamethoxazole‐trimethoprim were 52 .1% ,57 .3% ,42 .5% ,and 34 .7% ,respectively .CONCLUSION The E .cloacae isolates mainly lead to the re‐spiratory tract ,urinary tract ,and wound infections and are highly drug‐resistant .It is necessary to reasonably use antibiotics so as to control the nosocomial infections caused by the E .cloacae .