骨科患者医院感染革兰阴性杆菌构成及药敏监测

Gram-negative bacteria causing nosocomial infections in Orthopedics patients and their drug susceptibility

目的调查分析骨科患者医院感染革兰阴性杆菌构成及药敏情况,为指导临床合理使用抗菌药物、控制和延缓病原菌耐药性传播提供依据。方法回顾性分析医院2012-2014年骨科医院住院患者中确认为医院感染的病例。标本采集及分离培养严格按照《全国临床检验操作规程》进行。菌株鉴定采用法国梅里埃公司VITEK-2Compact微生物分析仪,药敏分析采用K-B法进行。结果共计送检标本669份,其中阳性618份,阳性率92.38%。阳性标本以分泌物(29.94%)、尿液(28.64%)和痰液(27.99%)为主。分离菌株数居前4位的病原菌依次为铜绿假单胞菌(156株,25.24%)、鲍曼不动杆菌(99株,16.02%)、大肠埃希菌(94株,15.21%)、肺炎克雷伯菌(84株,13.59%)。其中铜绿假单胞菌和鲍曼不动杆菌的构成比逐年上升。主要革兰阴性杆菌对亚胺培南、美洛培南的耐药率较低,铜绿假单胞菌和鲍曼不动杆菌对抗菌药物耐药率总体高于大肠埃希菌和肺炎克雷伯菌。在耐药率变迁方面,主要革兰阴性杆菌对各抗菌药物耐药率均有不同程度的上升。其中环丙沙星和左氧氟沙星的耐药率上升明显。结论骨科患者医院感染以铜绿假单胞菌为主,革兰阴性杆菌的耐药性已非常严重,应重视抗菌药物的使用和管理工作,预防与控制医院感染暴发流行。

Objectives To investigate the Gram-negative bacteria causing nosocomial infections in Orthopedics patients and to analyze their drug susceptibility in order to provide evidence for appropriate use of antibiotics in clinical practice and to control drug resistance. Methods Patients in Orthopedics who developed a nosocomial infection from 2012-2014 were retrospectively analyzed. Results In total,669 laboratory specimens were examined.Of these,618 tested positive for Gram-negative bacteria at a rate of 92.38%.Positive specimens were primarily secretions,urine,and sputum.The top 4Gram-negative bacteria that were isolated were Pseudomonas aeruginosa（25.24%）,Acinetobacter baumannii（16.02%）,Escherichia coli（15.21%）,and Klebsiella pneumoniae（13.59%）.P.aeruginosaand A.baumannii increasingly accounted for a greater proportion of nosocomial infections each year.The predominant Gram-negative bacteria had low resistance to imipenem and meropenem.In general,P.aeruginosaand A.baumannii were more resistant to antibiotics than E.coli and K.pneumoniae.The predominant Gram-negative bacteria are increasingly resistant to antibiotics each year,and resistance to ciprofloxacin and levofloxacin has increased markedly. Conclusion P.aeruginosais a predominant Gram-negative bacterium that caused nosocomial infections in Orthopedics patients,and Gram-negative bacteria are severely resistant to antibiotics.In clinical practice,considerable importance should be attached to the rational use of antibiotics to prevent and control outbreaks of nosocomial infections.