口腔医院颌面外科患者细菌耐药监测分析

Bacteria drug resistance surveillance of maxillofacial surgery patients in stomatology hospital

目的 研究口腔医院颌面外科患者检出细菌的分布和耐药情况，为临床抗菌药物的选用和多重耐药菌的目标监测提供依据。方法 收集中山大学附属口腔医院2012年1月至2014年12月颌面外科感染患者检出的菌株，对检出病原菌的分布和耐药情况进行回顾性分析，各年份间耐药率的差异性应用卡方检验统计分析， P＜0.05为差异有统计学意义。结果 共检出病原菌689株，革兰阳性菌占31.8%（219/689），革兰阴性菌占68.2%（470/689）。检出总量排名前3位的病原菌为铜绿假单胞菌、肺炎克雷伯菌和草绿色链球菌，检出量分别为96、67和51株。3个年份所分离的铜绿假单胞菌对头孢二代、三代的耐药率低于10%，对限制级抗菌药物美洛培南（χ2 = 2.675，P = 0.229）、氨曲南（χ2 = 0.469，P = 0.791）的耐药率低于8%。3个年份分离的金黄色葡萄球菌对青霉素的耐药率分别为90.0%、66.7%、95.2%，均高于60%（χ2 = 7.212，P = 0.024）。2012、2013年所分离的阴沟肠杆菌对四环素类、磺胺类、部分头孢菌素类的耐药率超过20%。结论 2012—2014年口腔医院颌面外科检出的铜绿假单胞菌和肺炎克雷伯菌数量最多，金黄色葡萄球菌和阴沟肠杆菌的耐药情况最为严重。应着重加强对铜绿假单胞菌和肺炎克雷伯菌的感染控制，重点监测金黄色葡萄球菌和阴沟肠杆菌的耐药情况。

Objective To investigate the antibiotic resistance of clinical bacteria isolated from maxillofacial surgery patients in stomatology hospital in an effort to offer basis for the rational use of antibiotics and the target monitoring of multi-drug resistant bacteria. Methods All of the bacterial susceptibility results were collected according to maxillofacial surgery patients in stomatology hospital from 2012 to 2014. The data were analyzed by Chi-squared test. Results There were totally 689 strains of bacteria isolated. Gram positive and gram negative bacteria accounted for about 31.8%（219/689）and 68.2%（470/689）, respectively. The most of top three bacteria were Pseudomonas aeruginosa （96 strains）, Klebsiella pneumonia （67 strains） and Streptococcus viridians （51 strains）. The drug resistance rate of Pseudomonas aeruginosa to cephalosporins was lower than 10%. The drug resistance rate of Pseudomonas aeruginosa to meropenem （χ2 = 2.675,P = 0.229） and aztreonam （χ2 = 0.469,P = 0.791） were less than 8%. Among three years, 90.0%, 66.7%, 95.2% Staphylococcus aureus were resistance to penicillihe（χ2 = 7.212,P = 0.024）, respectively. More than 60% Enterobacter cloacae isolated from 2012 to 2013 were resistance to tetracycline, sulfonamide and cephalosporins. Conclusions The most common bacteria detected were Pseudomonas aeruginosa and Klebsiella pneumonia. The resistance situation for Staphylococcus aureus and Enterobacter cloacae was serious. It is necessary to pay great attention to the control of hospital-acquired infections caused by Pseudomonas aeruginosa and Klebsiella pneumonia, and carry out the targeted monitoring of the detection of special bacteria resistance.