2014年莱芜市人民医院住院病人病原菌分析

Analysis on Pathogenic Bacteria from Inpatients in Laiwu City People's Hospital,2014

目的探讨住院病人感染病原菌的分布、药物敏感性及其耐药性,以指导临床合理使用抗生素。方法采用美国BD phoenix100全自动微生物鉴定仪,对莱芜市人民医院2014年1~11月住院病人4 470份各类临床标本进行病原菌的培养、分离鉴定和药物敏感试验。结果 4 470份临床标本中,分离出致病菌1 064株,阳性率为23.80%。致病菌以革兰阴性菌最多,占67.95%,主要为大肠埃希菌、绿铜假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌;革兰阳性菌占27.44%,主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌和屎肠球菌;真菌占4.60%,主要是白色假丝酵母菌和克柔假丝酵母菌。检出的革兰阴性杆菌中,致病性大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南、哌拉西林/他唑巴坦、阿莫西林/克拉维酸、阿米卡星具有较高的敏感性;大肠埃希菌对氨苄西林、哌拉西林、四环素和头孢唑啉的耐药率较高,均在80%以上;肺炎克雷伯菌对头孢唑啉、氨苄西林100%的耐药。鲍曼不动杆菌对米诺环素和多粘菌素敏感性较高,均在95%以上;但对氨曲南、氨苄西林、阿莫西林/克拉维酸、头孢唑啉和哌拉西林100%的耐药。铜绿假单胞菌对多粘菌素、美罗培南、亚胺培南亦有较高的敏感性,均在90%以上;但对氨苄西林/舒巴坦、头孢唑啉、氨苄西林、头孢噻肟等100%的耐药。革兰阳性菌对万古霉素、替考拉宁几乎完全敏感;但对青霉素、氨苄西林、红霉素和克林霉素耐药性较高。结论住院病人感染病原菌对抗菌药物产生了程度不同的耐药性,及时了解和掌握住院病人致病菌的分布、药物敏感性及其耐药性,可有效指导临床合理使用抗菌药物,避免滥用抗生素。

Objective To explore the distribution,drug sensitivity and itsresistance of inpatient infection pathogens,so as to conduct the rational use of antibiotics. Methods Using America BD phoenix100 automatic microorganism identification instrument,conduct culturing,identification and drug sensitivity test on pathogen for 4 470 copies of clinical specimens of inpatients in Laiwu People＇s Hospital during January-November,2014. Results In 4 470 copies of specimens,1 064 strains of pathogenic bacteria were isolated,in which the positive rate was 23.80%.In pathogenic bacteria,gram-negative bacteria were the most with 67.95%,mainly for Escherichia coli,green copper Pseudomonas,Klebsiella pneumoniae,Bauman Acinetobacter;gram-positive bacteria was 27.44%,mainly for Staphylococcus aureus,coagulase negative Staphylococcus and Enterococcus faecium;fungi was 4.60%,mainly for white Candida albicans and Candida krusei.In gramnegative bacilli,pathogenic Escherichia coli and Klebsiella pneumoniae had higher sensitivity on imipenem,meropenem,piperacillin/tazobactam,amoxicillin/clavulanic acid,Amikacin;Escherichia coli had higher resistance on ampicillin,piperacillin,tetracycline and cefazolin,and were all above 80%;Klebsiella pneumoniae had 100% drug resistance on cefazolin and ampicillin.Bauman Acinetobacter had 95% drug sensitivity on minocycline and polymyxin;but 100% resistant on aztreonam,ampicillin,amoxicillin/clavulanic acid and cefazolinand piperacillin.Pseudomonas aeruginosa to polymyxin,meropenem,imipenemalso had a higher sensitivity,all are in 90% above;but resistant to ampicillin/Shubatan,cefazolinand ampicillin,cefotaxime and other 100%.Gram-positive bacteria were almost sensitive on vancomycin,teicoplanin;but had higher resistance onpenicillin,ampicillin,erythromycin and clindamycin. Conclusion The pathogenic bacteria produce resistance on antibiotics in different degree,timely understand and grasp the distribution,drug sensitivity and itsresistance of inpatient pathogenic bacteria,it can effectively guide the rational use of antimicrobial drugs and avoid the abuse of antibiotics.