医院革兰阳性菌分布及耐药性分析

Distribution and drug resistance analysis of Gram-positive bacterial in the hospital

目的了解医院革兰阳性菌的分布及耐药性。方法回顾性分析2014年南京医科大学第一附属医院各类标本中分离的革兰阳性菌相关资料。细菌鉴定采用API系统或VITEK 2 Compact自动鉴定仪,药物敏感性检测采用纸片扩散法或VITEK 2 Compact全自动分析仪。结果共分离出各类病原菌7931株;其中,革兰阳性菌占20.7%。排名前3位的革兰阳性菌为金黄色葡萄球菌(35.4%)、凝固酶阴性的葡萄球菌(19.3%)和屎肠球菌(10.1%)。革兰阳性菌主要来源于痰液(21.9%)、伤口分泌物(17.4%)、血液(16.8%)和尿液(15.5%)。耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌的检出率分别为55.6%和68.3%。检出葡萄球菌中,16株对利奈唑胺耐药,6株对替考拉宁耐药,38株对替考拉宁中介,未发现对万古霉素耐药。耐万古霉素肠球菌的检出率为5.0%。结论该院耐甲氧西林金黄色葡萄球菌分离率逐年降低,耐万古霉素肠球菌分离率升高。

Objective To study the distribution and antimicrobial resistance of Gram-positive bacterial in the hospital.Methods The data of Gram-positive bacteria separated from all kinds of specimen in the First Affiliated Hospital of Nanjing Medical University during 2014 were retrospectively analyzed.Bacterial identification was performed using API system or VITEK 2 Compact automatic identification system.Antimicrobial susceptibility test was carried out by disk diffusion test or VITEK 2 Compact automatic bacteria analyzer.Results A total of 7931 clinical isolates was identified,of which Gram-positive bacteria occupied 20.7%.The top three pathogens were Staphylococcus aureus（35.4%）,coagulase-negative Staphylococcus（26.7%）and Enterococcus faecium（10.1%）.Of the 1641 strains of Gram-positive bacteria,21.9% were isolated from sputum,17.4% from wound secretion,16.8% from blood and 15.5% from urine.The isolation rates of methicillin-resistant strains in Staphylococcus aureus and coagulase-negative Staphylococcus were55.6% and 68.3%,respectively.None of Staphylococcus isolates was found to be resistant to vancomycin,while sixteen strains were resistant to linezolid and six strains were resistant to teicoplanin.Thirty-eight strains were intermediary sensitive to teicoplanin.Vancomycin-resistant Enterococcus accounted for 5.0%.Conclusion The isolation rate of methicillin-resistant Staphylococcus aureus has been decreasing year by year,while that of vancomycin-resistant Enterococcus is increased in the hospital.