临床常见病原菌分布与耐药性研究

Analysis of distribution and antibiotic resistance of common clinical pathogens

目的了解医院常见病原菌分布及耐药性,为临床合理选用抗菌药物提供依据。方法选取2008年1月-2012年12月14 227株病原菌,鉴定采用VITEK微生物分析仪,药物敏感性试验采用BIOMIC药敏测定仪,耐药性分析采用WHONET5.4软件。结果在14 227株临床分离菌中革兰阴性菌8 257株占58.0%,革兰阳性菌3 187株占22.4%,真菌2 783株占19.6%,最常见的菌种依次为铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、鲍氏不动杆菌、肺炎克雷伯菌,铜绿假单胞菌在高压氧科检出较高,鲍氏不动杆菌在ICU检出较高,大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌在内科病区检出较高;除大肠埃希菌主要检自尿标本外,上述4种菌主要检自痰标本;耐甲氧西林金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)检出率分别为70.6%、73.7%,金黄色葡萄球菌对利奈唑胺和万古霉素的敏感性最好,未发现耐药株,对呋喃妥因敏感性次之,耐药率为0.9%。结论加强细菌耐药性监测,推动临床抗菌药物的合理使用。

OBJECTIVE To investigate the distributions and antibiotic resistances of the common pathogens in our hospital ,so as to provide references for reasonable choice of antibiotics .METHODS Totally 14227 bacteria during Jan .2008 to Dec .2012 were identified by the VITEK system ,antibiotic sensitivity was tested by the BIOMIC , and the results of antimicrobial resistance were analyzed by WHONET 5 .4 software .RESULTS Among the 14 227 isolates ,gram‐negative bacteria accounted for 58 .2% （8257 isolates） ,gram‐positive ones 23 .1% （3 187 isolates） and fungi 18 .7% （2 783 isolates） .The common species were Pseudomonas aeruginosa （16 .6% ） ,Escherichiacoli （12 .0% ） , Klebsiella pneumoniae （10 .1% ） , Acinetobacter baumannii （8 .9% ） and Staphylococcus aureus （7 .5% ） .In point of clinical distributions ,the detection rate of P .aeruginosa was high in the department of hy‐perbaric oxygen ,A .baumannii high in ICU ,and the detection rates of E .coli ,K .pneumoniae and S .aureus were high in the department of internal medicine .The bacteria mentioned above were isolated from sputum except for Escherichia coli which was from urine .The detection rates of methicillin‐resistant S .saureus （MRSA） and methi‐cillin‐resistant coagulase‐negative Staphylococci （MRCNS） were 70 .6% and 73 .7% ,respectively .The suscepti‐bilities of S .aureus to vancomycin and linezolid were the best ,no resistant strains were detected ,followed by ni‐trofurantoin with the resistance rate of 0 .9% .CONCLUSION Antimicrobial resistance supervision should be strengthened ,which will promote the reasonable use of antimicrobials .