某三甲综合医院多重耐药菌分布及耐药性分析

Distribution and antibacterial resistance of multidrug-resistant pathogens in tertiary grade A comprehensive hospital

目的了解某三甲综合医院多重耐药菌株的科室分布及耐药性分析,以采取针对性的预防、控制和治疗措施。方法回顾性分析该院2014年1～12月检出的1 816株多重耐药菌数据。结果 1 816株多重耐药菌中以产超广谱β-内酰胺酶（ESBLs）的大肠埃希菌居首位（665株,36.62%）,然后依次为耐甲氧西林金黄色葡萄球菌（387株,21.31%）、耐碳青霉烯类抗菌药物的鲍曼不动杆菌（295株,16.22%）、多重耐药/泛耐药铜绿假单胞菌（195株,10.74%）、耐碳青霉烯类抗菌药物的肠杆菌科细菌（144株,7.92%）、产ESBLs的肺炎克雷伯菌（130株,7.16%）。分离到的多重耐药菌株主要集中在泌尿外科（384株,21.14%）、烧伤科（325株,17.90%）、重症监护室（ICU,266株,14.52%）、神经外科（110株,6.04%）。耐甲氧西林金黄色葡萄球菌对万古霉素和利奈唑胺的耐药率为0.0%;产ESBLs大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率较低,小于2.9%;耐碳青霉烯类抗菌药物的肠杆菌科细菌对阿米卡星、复方磺胺甲噁唑、美洛培南和四环素的耐药率较低（39.6%～60.7%）;耐碳青霉烯类抗菌药物的鲍曼不动杆菌对左旋氧氟沙星、四环素、复方磺胺甲噁唑和头孢哌酮/舒巴坦耐药率较低（48.9%～76.5%）;多重耐药/泛耐药铜绿假单胞菌对阿米卡星、头孢他啶、庆大霉素和环丙沙星耐药率较低（45.3%～66.7%）。结论应加强对高危科室的监控,制定有针对性的预防控制措施,并根据药敏结果进行临床用药。

Objective To investigate the characteristics of department distribution and antibacterial resistance of multidrug‐re‐sistant（MDR） pathogens in hospital ,and take specific measures for the prevention ,treatment and infection cntrol .Methods Data of 1 816 MDR isolates detected in the hospital from January to December in 2014 were analyzed retrospectively .Results Among the 1 816 MDR strains ,extended‐spectrum β lactamases（ESBLs） producing Escherichia coli ranked first（665 strains ,36 .62% ） ,fol‐lowed by methicillin‐resistant Staphylococcus aureus（387 strains ,21 .31% ） ,MDR Acinetobacter baumannii（295 strains ,16 .22% ） , MDR Pseudomonas aeruginosa（195 strains ,10 .74% ） ,carbapenem‐resistant Enterobacteriaceae（144 strains ,7 .92% ） ,ESBLs pro‐ducing Klebsiella pneumoniae（130 strains ,7 .16% ） .MDR strains were mainly distributed in general department of urology surgery （384 strains ,21 .14% ） ,burn unit（325 strains ,17 .90% ） ,intensive care unit（ICU ）（266 strains ,14 .52% ） and department neurosur‐gery（110 strains ,6 .04% ） .Vancomycin and linezolid resistance were not found in methicillin‐resistant Staphylococcus aureus ;less than 2 .9% of the ESBLs producing Escherichia coli and Klebsiella pneumonia strains were resistant to carbapenems .The resistance of carbapenem‐resistant Enterobacteriaceae to amikacin ,sulfamethoxazole‐trimethoprim ,meropenem and tetracycline were relatively low （39 .6% -60 .7% ） .The resistance of MDR Acinetobacter baumannii to levofloxacin ,tetracycline ,sulfamethoxazole‐trime‐thoprim and cefoperazone‐sulbactam were relatively low （48 .9% -76 .5% ） .The resistance of MDR Pseudomonas aeruginosa to amikacin ,ceftazidime ,gentamicin and ciprofloxacin were relatively low（45 .3% -66 .7% ） .Conclusion The MDR pathogens should be monitored in high‐risk department ,preventive measures should be taken ,and antibiotics should be used according to the results of drug susceptibility tests .