耳鼻喉科患者病原菌分布与耐药性分析

Distribution and drug resistance of pathogens isolated from patients of otolaryngology department

目的调查耳鼻喉科住院患者病原菌分布和耐药性,为防治医院感染提供理论依据。方法回顾性分析医院耳鼻喉科2012年4月-2015年4月收治1 293例患者的临床资料,调查分析感染部位、病原菌分布与耐药性;采取法国生物梅里埃公司VITEK-2细菌鉴定仪进行菌株鉴定,采用SPSS19.0软件进行统计分析。结果 1 293例患者中发生医院感染98例,感染率为7.6%;共分离出病原菌84株,其中革兰阴性菌46株占54.8%,革兰阳性菌28株占33.3%,真菌10株占11.9%;铜绿假单胞菌对头孢唑林、头孢呋辛、氨苄西林和阿莫西林/克拉维酸等抗菌药物耐药率较高,>70.0%,肺炎克雷伯菌对氨苄西林的耐药率为92.3%,金黄色葡萄球菌对红霉素和青霉素G高度耐药,耐药率为50.0%和91.7%,表皮葡萄球菌对红霉素、青霉素G和苯唑西林等抗菌药物高度耐药,耐药率≥80.0%。结论耳鼻喉科患者医院感染率高,感染病原菌以革兰阴性菌为主,临床应加强病原菌监测,根据药敏试验结果合理选择抗菌药物进行治疗。

OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from the hospitalized patients of otolaryngology department so as to provide theoretical basis for prevention and treatment of nosocomial infections.METHODS The clinical data of 1 293 patients who were treated in the department of otolaryngology from Apr 2012 to Apr 2015 were retrospectively analyzed,then the infection sites and distribution and drug resistance of pathogens were investigated,the strains were identified by using VITEK-2bacterial identification system,and the statistical analysis was performed with the use of SPSS19.0software.RESULTS Of the 1 293 patients,98had nosocomial infections,with the infection rate 7.6%.A total of 84 strains of pathogens were isolated,including 46（54.8%）strains of gram-negative bacteria,28（33.3%）strains of gram-positive bacteria,and10（11.9%）strains of fungi.The drug resistance rates of the Pseudomonas aeruginosa to cefazolin,cefuroxime,ampicillin,and amoxicillin-clavulanic acid were more than 70.0%;the drug resistance rate of the Klebsiella pneumoniae to ampicillin was 92.3%;the drug resistance rates of the Staphylococcus aureus to erythromycin and penicillin G were 50.0% and 91.7%,respectively;the drug resistance rates of the Staphylococcus epidermidis to erythromycin,penicillin G,and oxacillin were no less than 80.0%.CONCLUSIONThe prevalence rate of nosocomial infections is high in the patients of otolaryngology department.The gram-negative bacteria are dominant among the pathogens causing the infections.It is necessary for the hospital to strengthen the surveillance of pathogens and reasonably use antibiotics on basis of the results of the drug susceptibility testing.