15249株院内感染病原菌分布及耐药性分析

Analysis of distribution of 15 249 strains of nosocomial infection pathogens and drug resistance

目的监测陆军军医大学第一附属医院各科室住院患者病原菌分布及体外耐药情况,分析各病原菌的流行情况。方法对2016年该院临床标本培养出的15 249株病原菌及药敏试验结果进行回顾性统计分析。采用纸片扩散法(K-B法)或自动化仪器法(MIC法)对临床分离菌株进行药敏试验。按2017年CLSI-M100文件标准判定药敏结果,采用WHONET5.5软件进行数据分析。结果 2016年全院共分离15 249株病原微生物,其中革兰阴性菌9 742株,同比2015年下降11.45%;革兰阳性菌4 188株,同比上升15.34%;真菌1 319株,同比下降11.48%。微生物培养标本送检量排名前五的科室为:烧伤科、儿科、ICU、肝胆外科、脑外科。微生物培养标本送检以痰液标本为主,占微生物送检标本的27.28%,其次是血液、伤口分泌物、尿液、腹水等标本。前5位病原菌依次为肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌。结论该院住院患者的感染以革兰阴性菌为主,但革兰阳性菌也是重要致病菌,应根据药敏实验结果选择抗菌药物,重视病原菌的分布及药物敏感性的变迁,为临床抗感染治疗提供有效的理论依据。

Objective To monitor the distribution of pathogens and the drug resistance of inpatients in Southwest Hospital in ChongQing,and to analyze the prevalence of pathogens in various departments. Methods A total of 15 249 pathogens cultured from clinical specimens in our hospital in 2016 and the antimicrobial susceptibility testing results were retrospectively analyzed. The anti-microbial susceptibility testing was carried out by using the paper diffusion method （K-B） or the automated instrument method （MIC）. The data were analyzed by WHONET5. 5 software according to the standard of CLSI2017-M100. Results Compared with 2015,a total of 15 249 pathogenic microorganisms were isolated from the hospital in 2016,among which 9 742 were Gram-negative bacteria,down 11.45% and 4 188 were Gram-positive bacteria, up 15. 34% and 1319 were fungi, down 11. 48%. Top five departments which collected most microbiological culture specimen were Burn, Pediatric, ICU, Hepatobiliary surgery, Neurosurgery. The main specimen type of culture was sputum,accounting for 27. 28% followed by blood,wound secretion,urine？abdominal fluid. The first five pathogens were Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa. Conclusion Gram-negative bacteria are mainly infected organisms in our hospital. However, Gram-positive bacteria are also important pathogens. Antibiotics should be selected according to the results of antimicrobial susceptibility testing. The distribution of pathogens and the changes of drug sensitivity should be emphasized, which can provide an effective theoretical basis for treatment.