医院感染监测常见病原菌在不同专业病房药敏结果分析

Analysis of antibiotic sensitivity of common pathogens in different wards by nosocomial infection surveillance

目的：了解医院不同病房主要病原菌的分布及药敏情况，指导临床合理预防及目标性治疗用药。方法：采用梅里埃VITEK-2Compact进行菌株的鉴定及药敏，耐碳青霉烯肠杆菌菌株采用改良Hodge实验进行验证，采用Whonet5．6进行数据耐药率分析。结果：四个不同病房检测出6549株病原菌（真菌除外），其中主要的病原菌为：肺炎克雷伯茵1094株，大肠埃希菌1055株，铜绿假单胞菌885株，金黄色葡萄球菌810株，鲍曼不动杆菌508株，肺炎克雷伯菌在不同病房的ESBLS的发生率分别为：ICU28．9％、内科系16．8％、外科系34．8％、儿科系18．6％，大肠埃希菌的ESBLS的发生率分别为：ICU69．9％、内科系5513％、外科系53．1％、儿科系45．1％，非发酵菌的检出率ICU明显高于非ICU病房，不同病房MRSA的检出率分别是：ICU31．铴、内科系15．3％、外科系21．3％、儿科系20．觋。大肠埃希菌、鲍曼不动杆菌耐药现象比较严重，未发现耐万古霉素、利奈唑胺的金黄色葡萄球菌。结论：同一病原菌在不同病房的分布及耐药率有差异，可能与临床科室对微生物病原检验的认识和热情不同有关，应开展有效的科室宣教，提高临床医生的送检意识，根据药敏合理使用抗生素，减缓耐药菌的产生。

Objective： This study aims to investigate the distribution and antibiotic susceptibility of major pathogens in different wards, and to guide the prevention and target therapy of clinical infection. Methods： The identification and antibiotic sensitivity of the bacteria were tested by the bioMerieux VITEK-2 Compact. The Enterobacteriaceae strain of Carbapenem resistant was verified by the modified Hodge experiment. The antibiotic resistance rate was analyzed by Whonet 5.6. Results： 6549 strains of pathogens （except fungi） were isolated and detected in the four different wards. The main pathogens were 1094 strains ofKlebsiella pneumoniae, 1055 strains of Escherichia coli, 885 strains ofPseudomonas aeruginosa, 810 strains of Staphylococcus aureus and 508 strains ofAcinetobacter baumannii. The incidence of ESBLs in Klebsiella pneumoniae was 28.9% in ICU, 16.8% in the department of internal medicine , 34.8% in the department of surgery , 18.6% in the department of pediatrics, and the incidence of ESBLs in Escherichia coli were 69.9 %, 55.3%, 53.1%, and 45.1% respectively in the four different wards. The detection rate of non-fermentative bacteria in ICU was significantly higher than in non-lCU ward, and the detection rate of MRSA in different wards were： 31.4%in ICU, 15.3% in the department of internal medicine, 21.3% in the department of surgery, 20.7% in the department of pediatrics. The antibiotic resistance in Escherichia coli and Acinetobacter baumannii was more serious, and the resistance ofvancomycin and linezolid was not found in Staphylococcus aureus. Conclusion： The distribution and resistance rates of the same pathogens in different wards were different. It may be due to the different cognition and enthusiasm about clinical microbiological examination in different clinical departments. It is necessary to carry out effective education and to raise the awareness of microbiological examination in different clinical departments to slow down the antibiotic resistance rates.