昆明医科大学第二附属医院感染菌分布及耐药性分析

Analysis of distribution and drug resistance of bacteria infection in the Second Affiliated Hospital of Kunming Medical University

目的了解昆明医科大学第二附属医院临床感染菌的分布及耐药情况,为细菌性感染的治疗提供依据。方法回顾性分析2013年1~12月该院临床分离菌4 802株,采用VITEK-2Compact细菌鉴定系统鉴定,纸片扩散法进行抗菌药物药敏试验,按美国临床实验室标准化协会（CLSI）2013年标准进行判定,并以WHONET5.6软件统计分析。结果菌株主要分离自尿液、痰液、血液、分泌物和脓液,分别占31.7%、21.4%、19.7%、11.7%、7.0%。分离菌中革兰阴性菌占55.8%,以大肠埃希菌（26.3%）为主;革兰阳性菌占31.7%,以凝固酶阴性葡萄球菌（15.0%）为主;真菌占3.1%,以白色假丝酵母菌为主。大肠埃希菌、肺炎克雷伯菌对碳青霉烯类药物最敏感,耐药率均小于10.0%。大肠埃希菌和肺炎克雷伯菌产超广谱β内酰胺酶（ESBLs）的检出率分别为61.1%、49.1%。非发酵革兰阴性菌中,除铜绿假单胞菌对阿米卡星有较好的敏感性外,铜绿假单胞菌和鲍曼不动杆菌对绝大多数抗菌药物都呈现很强的耐药性（耐药率大于50.0%）。在革兰阳性菌中,耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌检出率分别为42.3%和65.6%。屎肠球菌对大部分抗菌药物耐药性较高,除利奈唑胺和替考拉宁外,屎肠球菌对其他抗菌药物的耐药率均高于粪肠球菌,检出1株耐万古霉素的屎肠球菌。结论细菌耐药监测对指导临床合理使用抗菌药物,减少细菌耐药性有积极意义。

Objective To investigate the distribution and drug resistance of clinical bacteria infection in the Second Affiliated Hospital of Kunming Medical University,so as to provide reference for the treatment of bacterial infections.Methods 4 802 strains of bacteria isolated from this hospital,from January 2013 to December 2013,were retrospectively analysed.The isolates were identi-fied by using VITEK-2 Compact bacterial identification system.Drug resistance was measured by using disc diffusion test,and its results were interpreted according to the breakpoints of Clinical and Laboratory Standards Institute（CLSI）2013.WHONET 5.6 was applied for analysis.Results These pathogens were mainly isolated from urine,sputum,blood,secretions and pus,accounted for 31.7%,21.4%,1 9.7%,1 1.7% and 7.0%,respectively.In the clinical isolates,gram negative bacilli accounted for 55.8%, which was mainly Escherichia coli（26.3%）.Gram positive cocci accounted for 31.7%,,which was mainly coagulase negative staph-ylococcus（1 5.0%）.Fungi accounted for 3.1%,which was mainly Candida albicans.Escherichia coli and Klebsiella pneumonia were most sensitive to carbapenem,resistance rate was less than 10.0%.The detection rates of Escherichia coli and Klebsiella pneumoni-ae producing extended-spectrumβ-lactamases（ESBLs）was 61.1% and 49.1%,respectively.Among non-fermentative gram nega-tive bacilli,excepting Pseudomonas aeruginosa had good sensitivity to Amikacin,Pseudomonas aeruginosa and Acinetobacter bau-mannii showed high resistance to most antibiotics（resistance rate was more than 50.0%）.Among gram positive bacteria,the detec-tion rates of meticillin-resistant Staphylococcus aureus and methicillin-resistant coagulase negative Staphylococcus were 42.3% and 65.6%,respectively.The resistance rates of Enterococcus faecium to most of antibacterials were higher.Except for linezolid and teicoplanin,the resistances of Enterococcus faecium to other antibacterials were higher than those of Enterococcus faecalis.Only a strain of Enterococcus faecium resistant to vancomycin was isolated.Conclusion Resistance monitoring might have significance in guiding the clinical rational use of antimicrobial agents,and reducing the spread of antibiotic resistance in bacteria.