医院不同科室分离的大肠埃希菌耐药性分析及分布

Drug resistance and clinical distribution of Escherichia coli collected from different wards

目的了解院内不同科室分离的大肠埃希菌对临床常用抗菌药物的耐药性及分布,为临床经验用药提供理论依据。方法用WHONET 5.6对2014年1月至2014年12月本院儿内科病房分离的100株、ICU重症监护病房分离的56株和泌尿内科病房分离的176株大肠埃希菌对亚胺培南等19种抗菌药物的耐药性及分布进行分析。结果3个病区分离的大肠埃希菌对阿莫西林/克拉维酸、头孢西丁、阿米卡星、哌拉西林/他唑巴坦、亚胺培南、美罗培南和厄他培南的耐药率均〈20%,对氨苄西林、头孢唑啉、头孢呋辛、头孢噻肟、头孢他啶和头孢吡肟的耐药率为21.6%-92.9%,对阿米卡星、庆大霉素和妥布霉素的耐药率为1.7%-53.9%,对左氧氟沙星和环丙沙星的耐药率为39.0%-69.6%,对氨曲南和复方新诺明的耐药率为32.9%-71.4%。儿内科病房分离的大肠埃希菌中,57.0%（57/1 00）的标本来源于痰液,21.0%（21/100）的标本来源于分泌物。IC1J重症监护病房分离的大肠埃希菌中,28.6%（16/56）的标本来源于血液,26.8%（15/56）的标本来源于尿液。泌尿内科病房分离的分离的大肠埃希菌中,91.5%（161/176）的标本来源于尿液,5.7%（10/176）的标本来源于血液。结论院内3个病区分离的大肠埃希菌标本主要来源差异较大,对临床部分常用抗菌药物的耐药性相差较大,临床医师应及时掌握不同病房分离的大肠埃希菌的耐药性,可提高经验用药的准确率。

Objective To investigate the drug resistance and clinical distribution of Escherichia coli collected from different wards in our hospital,and to guide the rational clinical application of antibacterial.Methods Total of 100 stains of Escherichia coli were collected from pediatric ward,among which,56 strains were collected from the Intensive Care Unit and 176 strains were collected from Urological Ward from January 2014 to December 2014,the drug resistance to 19 antibacterial including imipenem and the clinical distribution were analyzed by WHONET 5.6,retrospectively.Results The drug resistance rates of Escherichia coli collected from the three wards to amoxicillin/clavulanic acid,cefoxitin,amikacin,piperacillin/tazobactam,imipenem,meropenem and ertapenem were all less than 20%;the resistance rates to ampicillin,cefazolin,cefuroxime,cefotaxime,ceftazidime and cefepime varied from 21.6%to 92.9%,the resistance rates to amikacin,gentamicin and tobramycin varied from 1.7%to 53.9%,the resistance rates to levofloxacin and ciprofloxacin were 39.0%to 69.6%,and the resistance rates to aztreonam and cotrimoxazole were 32.9 to 71.4%.Among the strains collected from pediatric ward,57%were obtained from sputum,21%were obtained from secretions.Among the strains collected from the Intensive Care Unit,28.6%were obtained from blood,26.8%were obtained from urine.Among the strains collected from urological ward,91.5%） were obtained from urine,5.7%were obtained from blood.Conclusions The main source of the specimens and the resistance rates to antibacterial drugs varied widely in Escherichia coli collected from the three wards,thus timely understand the drug resistance of Escherichia coli isolated from different wards can improve the accuracy of empirical medication.