急诊科感染患者微生物标本送检及临床分离菌分布和耐药分析

The species of pathogenic microorganism and the analysis of its antibiotic resistance in emergency department patients

目的：研究四川大学华西医院急诊科感染患者分离病原菌分布情况与耐药性，为临床治疗提供依据。方法选取2013年5月至2015年4月急诊科收治病例，分析其临床分离菌株的分布情况与药敏结果。结果分离菌株1622例，包括革兰阴性杆菌1237例，革兰阳性球菌324例，真菌60例，革兰阴性球菌1例，分别占76.3％、19.9％、3.7％、0.1％；分离率前五位的临床分离菌株分别为大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌，分别占21.4％，16.7％，12.4％，11.5％，6.5％；按标本类型分类，痰标本检出率最高，占46.6％，其次分别为血液、尿液、分泌物；多重耐药菌方面，产超广谱β内酰胺酶的大肠埃希菌（ ESBL-E.coil）和肺炎克雷伯菌（ESBL-KPN）检出率分别为62.0％和26.0％，耐碳青霉烯类鲍曼不动杆菌（CRAB）检出率为80.5％；耐甲氧西林金黄色葡萄球菌（ MRSA）检出率为26.5％，耐万古霉素屎肠球菌（ VRE）为9.4％，未查见耐万古霉素粪肠球菌。结论急诊科感染临床分离菌株种类丰富，尤以大肠埃希菌、鲍曼不动杆菌等革兰阴性杆菌为多，且耐药情况不容乐观，急诊科应及时与微生物实验室沟通，对临床分离菌株分布及耐药情况多加关注，并根据耐药分析结果合理使用抗生素。

Objective Explore the species of pathogenic microorganism and analysis the antibiotic resistance in Emergency department patients in West China Hospital, finding out the evidence for clinical therapy. Methods Select the patients from May 2013 to April 2015 in Emergency department, analyses the species of pathogenic microorganism and the result of drug sensitivity test.Results In the 1 622 cases, there are 1 237 cases of gram-negative bacilli, 324 cases of gram positive coccus, 60 cases of fungus and 1cases of gram-negative coccus, accounted for 76.3%, 19.9%, 3.7%and 0.1%respectively.The top five is E.coli, acinetobacter baumannⅡ, klebsiella pneumoniae, pseudomonas aeruginosa and staphylococcus aureus, accounted for 21.4%, 16.7%, 12.4%, 11.5% and 6.5%; according to the sample species, the detection rate of sputum is highest, accounted for 46.6%, next is blood, urine, secretion; in regard to multiple resistant bacteria, detection rate of ESBL-E.coil, ESBL-KPN , CRAB and MRSA is 62.0% , 26.0%, 80.5% and 26.5%; the detection rate of VREF is 9.4% and does not find Vancomycin resistant enterococcus bacteria. Conclusions The species of pathogenic microorganism in emergency department is rich, especially gram-negative bacilli as E.coli, acinetobacter baumannⅡ, and the drug resistance situation is not optimistic. Emergency department shall communicate with microbiology laboratory timely, pay attention to the situation of the species and the drug resistance result, take rational use of antibiotic according to the results of the analysis of drug resistance.