近两年医院感染常见病原菌分布及耐药性分析

Distribution and Drug Resistance of Common Pathogens of Hospital Infection in the Recent 2 Years

目的探讨住院患者医院感染常见病原菌的分布特点及其耐药特征,为指导临床合理应用抗菌药物提供参考依据。方法收集2013年至2014年医院各临床科室住院患者送检的标本进行检查,采用法国生物梅里埃公司的VITEK-2 Compact全自动细菌鉴定仪进行菌株鉴定及药物敏感性试验,并采用WHONET 5.5进行数据统计分析。结果共分离出9 149株感染病原菌,其中革兰阴性菌共6 647株,占72.65%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌为主;革兰阳性菌共2 502株,占27.35%,以金黄色葡萄球菌、肺炎链球菌、粪肠球菌、溶血葡萄球菌为主。大肠埃希菌和肺炎克雷伯菌对头孢唑林、头孢曲松和甲氧苄啶磺胺甲唑的耐药率均超过50%;流感嗜血菌对氨苄西林、左氧氟沙星和甲氧苄啶磺胺甲唑的耐药率分别为61.45%、60.24%和74.70%;阴沟肠杆菌对头孢曲松和氨曲南的耐药率分别为58.90%和50.92%。主要革兰阴性菌对阿米卡星、亚胺培南、美罗培南、头孢替坦、头孢西丁和头孢哌酮钠舒巴坦钠的耐药率较低,均低于20%;而主要非发酵菌中以鲍曼不动杆菌对常见抗菌药物的耐药率较高。主要革兰阳性菌除对万古霉素和利奈唑胺耐药率为0外,对其他常见抗菌药物均有不同程度的耐药率,其中对青霉素的耐药率均超过45%,对红霉素的耐药率均超过65%。屎肠球菌和粪肠球菌对万古霉素的耐药率分别为2.78%和1.15%,对利奈唑胺耐药率分别为2.78%和11.06%,对其他抗菌药物耐药率较高。结论医院常见病原菌以革兰阴性菌为主,对常见的抗菌药物的耐药率偏高,必须加强病原菌分布及耐药性检测,指导临床合理运用抗菌药物。

Objective To investigate the distribution and drug resistance of common pathogens, to provide guidance for reasonable clinical use of antibiotics and control nosocomial infections. M ethods Specimens were collected and indentified from 2013 to 2014 in hospitalized patients with various clinical departments. The bacterial identification was indentified and performed by VITEK- 2 Compact of Biomeriex, France, then the drug susceptibility testing was performed, and the data were analyzed by WHONET 5. 5 software. Results A total of 9 149 strains of pathogens were isolated from 2013- 2014, among which the gram- negative bacteria were 6 647 strains, accounting for 72. 65%, of which, and the top 4 pathogens in order were escherichia coli, klebsiella pneumonia, pseudomonas aeruginosa and acinetobacter baumannii; gram- positive bacterium were 2 502 strains, accounting for 27. 35%, and the top 4 pathogens in order were staphylococcus aureus, streptococcus pneumoniae, enterococcus faecalis, staphylococcus haemolyticus. The drug resistance rate of escherichia coli and klebsiella pneumonia to cefazolin, ceftriaxone and trimethoprim / sulfamethoxazole were more than 50%; the drug resistance rate of hemophilus influenzae to ampicillin, levofloxacin and rimethoprim / sulfamethoxazole were 61. 45%, 60. 24% and74. 70%, respectively; the drug resistance rate of enterobacter cloacae to ceftriaxone and aztreonam were 58. 90% and 50. 92%. The main gram- negative bacilli were especially sensitive to amikacin, imipenem, meropenem, cefotetan, cefoxitin, cefoperazone / sulbactam, and the drug resistance rate were more less 20%; the drug resistance rate of the main non- fermentataive bacterial to acinetobacter baumannii to common antibacterial drugs were high. The drug resistance rate of the main gram- positive bacteria in addition to vancomycin and linzolid were 0, and had different degrees of drug resistance rate to common antibacterial drugs, among which to penicillin was more than 45%, and to erythrocin were more than 65%. The drug resistance rate of enterococcus faecium and enterococcus faecalis to vancomycin were 2. 78% and 1. 15%, and to linezolid were 2. 78% and 11. 06%, but the drug resistance rate of enterococcus faecium and enterococcus faecalis to common antibacterial drugs were high. Conclusion Pathogenic bacteria are the main gram- negative bacilli in clinic, and they have drug resistance rate to common antibacterial, thus drug resistance monitoring should be strengthened in order to instruct rational use of antibiotics.