临床常见感染菌群的分布特征及耐药趋势分析

Distribution of micro-organisms commonly found in infections and their tendency of resistence to drugs

目的:了解近年来北京市积水潭医院患者临床常见病原菌的分布及耐药性的变迁,为临床合理应用抗生素提供依据。方法:选择2010—2014年我院临床送检样品分离到的细菌,回顾性分析其来源、分布规律、对各种抗生素的耐药情况。结果:我院近5年临床分离菌中,革兰阴性杆菌所占比例高于革兰阳性球菌,革兰阳性球菌的感染率逐年增加,金黄色葡萄球菌和表皮葡萄球菌的感染呈现明显上升趋势。从阳性标本来源分析痰标本居第一位,其次为伤口分泌物。我院临床分离的革兰阴性菌主要包括大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和鲍曼醋酸钙不动杆菌。2012年我院分离到的产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的比例高达88.3%,2014年我院分离到产碳青霉烯水解酶(KPC)的肺炎克雷伯菌占9.5%,鲍曼不动杆菌对大多数的抗生素耐药率都维持在50%以上。临床分离的革兰阳性菌主要为金黄色葡萄球菌和表皮葡萄球菌,2014年我院耐甲氧西林金黄色葡萄球菌比例为42.2%。结论:我院常见病原菌的耐药性有增强趋势,在抗感染治疗中需要注重抗生素的合理应用及联合用药。

Objective： To investigate the features of distribution of bacteria and their resistance against antimicrobial agents in recent years in Jishuitan Hospital, and ventured to seek suitable solutions for the problems. Methods： Bacteria were isolated from clinical specimens 2010 to 2014 in Jishuitan Hospital, and a retrospective analysis of its origin, distribution, drug resistance to various antibiotics was made. Results： Among clinical isolates in our hospital in recent 5 years, the proportion of gram negative bacilli was highest, followed by Gram positive cocci. The rate of gram positive cocci infection was increasing year by year. The Staphylococcus aureus and Staphylococcus epidermidis infections showed a clear ascending trend. The specimens were obtained from sputum, which was the main source of the isolated bacteria from infections in our hospital. The next source of positive culture was wound exudates. Isolated Gram negative bacteria were mainly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumanii and Bauman Acinetobacter calcoaceticus. The incidence rate of extended spectyum β lactamase（ESBLs）-producing Escherichia coli isolated in our hospital in 2012 reached as high as 88.3%. For severe infection caused by Escherichia coli the use of imipenem or meropenem was recommended. In 2014, Klebsiella pneumoniae, which produced carbapenem hydrolase（KPC） accounted for 9.5%, and resistance of Bauman Acinetobacter to most of the antimicrobial maintained above 50%. Common gram positive bacteria isolated were Staphylococcus aureus and Staphylococcus epidermidis. In 2014, the drug resistance rate of Staphylococcus aureus was 42.2%. Conclusions： Drug resistant microorganisms show an increasing trend. More attention should be paid to the rationality of combined use of drugs in order to alleviate the trend of drug resistance of bacteria in infection.