2012年至2014年医院感染病原菌分布及耐药性分析

Distribution and Drug Resistance Pathogens Causing Nosocomial I nfe ction During 2012 - 2014

目的分析医院感染病原菌的分布特点及耐药现状,为临床治疗和合理用药提供依据。方法对医院2012年至2014年临床分离菌,采用法国梅里埃公司生产的VITEK-2 Compact全自动微生物分析仪做鉴定和药敏试验,WHONET 5.6软件对数据进行统计分析。结果 2012年1月至2014年12月,收集临床分离菌共8 441株,其中革兰阴性杆菌6 562株,占77.7%;革兰阳性球菌1 879株,占22.3%。感染常见部位仍为呼吸道和泌尿系统,发生率较高的科室是普外科、ICU、肾内科。检出前5位的细菌分别是大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌。3年间,大肠埃希菌和肺炎克雷伯菌对碳青酶烯类抗生素仍高度敏感,总的敏感率在97.3%~99.9%。非发酵菌在医院感染中占很高比例,鲍曼不动杆菌和铜绿假单胞菌对碳青酶烯类的敏感率有降低的趋势,鲍曼不动杆菌多药耐药性非常严重,对亚胺培南和美洛培南的敏感率〈34.9%。铜绿假单胞菌对亚胺培南敏感率〈36.1%,对美洛培南敏感率〉66.8%。金葡菌和凝固酶阴性葡萄球菌中甲氧西林耐药株（MRSA）和（MRCNS）的检出率分别为40.7%和86.8%,未发现耐万古霉素和利奈唑胺葡萄球菌,肠球菌检出少量万古霉素和利奈唑胺耐药株。结论医院常见病原菌的菌种类别较多,不同细菌耐药性存在一定差异,应合理选用抗菌药物,加强临床抗菌药物管理和细菌耐药性监测。

Objective To investigate the pathogenic distribution and drug resistance status in nosocomial infection so as to provide basis for the reasonable clinical application of antibiotics. Methods pathogens of 8441 strains isolated from our hospital from 2012 to 2014 were analyzed. VITEK - 2 Compact Full Automated Micro- biology Analyzer was used for bacterial identification and the drug susceptibility tests and the data of drug resis- tance were statistically analyzed with the use of whonet 5.6 software. Result From Jan 2012 to Dec 2014, a to- tal of 8 441 clinical isolates were collected, of which Gram- negative bacilli 6 562, accounting for 77.7 % ;Gram -positive cocci 1 849, accounting for 22.3 %. The most common sites of nosocomial infection were respiratory tract and urinary system. The nosocomial infection occurred more in department of ICU, Department of general surgery, Urinary Department of internal Medicine. The top 5 bacteria of nosocomial infection were Escherichia coli, Pseudomonas aeniginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus. During three years, Escherichia coli and Klebsiella pneumoniae were still highly susceptible to the carbapenems, the over- all sensitivity rate being 97.3 % -- 99.9 %. Non - fermenting bacteria were the common ones causing nosocomial infection in our hospital. The multi - drug resistance of Acinetobacter baumannii was very serious, sensitivity rates to imipinem and meropinem were below to 34.9 %. The sensitivity rate of Pseudomonas aeniginosa to Imipenem was below to 36.1%, which to Meropenem was over 66.8 %. The average prevalence of methicillin - resistant strains in Staphylococcus aureus （MRSA） and coagulase- negtive Staphyloccus（MRCNS）was 70.7 % and 86.8 %. No staphyloccal strain was found resistant to vancomycin and linezolid. Some strains of Enterococcus faecium and Enterococcu faecium were resistant to vancomycin and linezolid. Conclusion There are a variety of species of bacteria causing nosocomial infection, which vary in the drug resistance. We should strengthen the ad- ministration of the clinical antibacterial drug usage and the monitoring of drug- resistance.