临床不同来源标本中分离细菌的耐药性分析

Antimicrobial resistance of bacterial isolated from different samples

目的探讨临床不同来源标本分离的同种细菌对抗菌药物的敏感性有无差异,以便指导临床合理运用抗菌药物。方法对本院各科室2009～2013年送检的痰液、血液、脓液及尿液标本分离的细菌采用全自动微生物鉴定药敏仪检测,并比较4种标本来源的金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌对抗菌药物的耐药性差异。结果 4种标本分离的大肠埃希菌和肺炎克雷伯菌对亚胺培南、厄他培南、哌拉西林/他唑巴坦及阿米卡星的耐药率均低,分离的金黄色葡萄球菌均对万古霉素、利奈唑胺、呋喃妥因、喹奴普丁/达福普丁的耐药率低。分离自痰液的大肠埃希菌超广谱β-内酰胺酶（ESBLs）阳性率为71.5%,耐甲氧西林金黄色葡萄球菌（MRSA）检出率为79.9%,高于其他3种标本（P〈0.05）。尿液中产ESBLs肺炎克雷伯菌检出率为44.4%,高于其他3种标本,差异有统计学意义（P〈0.05）。结论不同标本分离的同种细菌对多种抗菌药物耐药率不同,建议临床医师在治疗不同标本检出同种细菌引起的感染时,应根据药敏结果合理使用抗菌药物。

Objective To explore the differences in antimicrobial resistance of bacteria isolated from different samples ,and to guide antibiotic chemotherapy in clinic .Methods The sputum ,blood ,pus and urine specimens were collected from 2009 to 2013 in our hospital for bacterial identification and drug sensitivity tests by using automatic system .The drug resistance rate of Staphylo‐coccus aureus ,Escherichia coli ,Klebsiella pneumoniae isolated from different samples were compared .Results All isolates of E .co‐li ,Klebsiella pneumoniae were sensitive to imipenem ,ertapenem ,piperacillin/tazobactam and amikacin .All isolates of S .aureus were sensitive to vancomycin ,linezolid ,nitrofurantoin ,quinupristin/dalfopristin .The ESBLs positive rate of E .coli（71 .5% ）and the MR‐SA detection rate（79 .9% ） of Staphylococcus aureus from sputum samples were significantly higher than that from other samples （P〈0 .05） .The ESBLs positive rate（44 .4% ） of Klebsiella pneumoniae isolates from urine was significantly higher than that from other samples（P〈0 .05） .Conclusion The same bacteria isolated from different samples have different antimicrobial resistance rates ,so the selection of antibiotics should based on drug sensitivity tests results for the treatment of the same pathogen infection confirmed by bacterial cultures from different samples .