医院感染病原菌分布与耐药性研究

Distribution and drug resistance of pathogens causing nosocomial infections

目的为临床医师结合患者病种、菌种特点及药敏结果合理选择抗菌药物提供参考依据,以提高医院感染预防控制效力。方法统计分析2014年1-6月从临床送检培养标本中分离出的16 598株病原菌,菌株经WalkAway96PLUS自动化微生物鉴定仪NC31复合板进行鉴定和药敏试验,采用WHONET软件进行统计处理。结果病原菌检出排名前18位的科室中内科系统占61.1%、外科系统占38.9%;铜绿假单胞菌对抗菌药物耐药率均<30.0%,持续下降趋势;鲍氏不动杆菌对碳青霉烯类等抗菌药物耐药率快速上升,对亚胺培南耐药率为63.1%、对美罗培南耐药率为64.0%;产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌的检出率分别为8.7%和5.5%。结论内科系统各病原菌检出数大多高于或近似于外科系统;近来常见菌种对抗菌药物的敏感性和耐药性有变迁,应依据药敏结果,合理选用或调整抗菌药物,有效防治感染。

OBJECTIVE To investigate the species, distribution, and drug susceptibility of the pathogens causing nosocomial infections so as to provide guidance for prevention and control of the nosocomial infections. METHODS A total of 16598 strains of pathogens were isolated from the clinical submitted specimens from Jan 2014 to Jun 2014, then the strains were identified by using WalkAway96PLUS automatic microorganism identification system NC31 composite board, the drug susceptibility testing was carried out, and the statistical analysis was performed with the use of WHONET software. RESULTS Among the departments ranking the top 18 of the number of spe- cies of pathogens, there were 11 （61.1%） internal medicine departments and 7 （38. 9%） surgery departments. The drug resistance rate of the Pseudomonas aeruginosa was less than 30.0% and showed a downward trend; the drug resistance rate of the Acinetobacterbaumannii to carbapenems showed an increasingly upward trend, the drug resistance rate to imipenem was 36.1%, and the drug resistance rate to meropenem was 64.0%. The isolation rates of ESBLs-produeing Escherichia coli and ESBLs-producing Klebsiella pneumoniae were 8.7% and 5.5 %, respectively. CONCLUSION The number of species of the isolated pathogens is larger in or approximates to the in- ternal medicine departments than in the surgery departments. The drug susceptibility and resistance of the com- mon species have changed in recent years, and it is necessary to reasonably use antibiotics or adjust the drug thera- py based on the results of the drug susceptibility testing so as to effectively prevent the infection.