2012―2016年重庆市某院临床分离主要病原菌分布及耐药性变迁

The distribution and drug resistance changes of the main pathogenic bacteria in a hospital in Chongqing within 2012―2016

目的了解某院临床分离的主要病原菌分布及耐药性的变迁,为临床合理应用抗菌药物提供依据。方法回顾性分析某院2012年1月至2016年12月临床分离的2 453株病原菌的分布及药敏试验结果。结果共检出2 453株非重复病原菌,病原菌排名前5位依次为白色假丝酵母菌、大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌、肠球菌属。其中革兰阴性杆菌为主要病原菌,占1 103株(45.0%),产超广谱β-内酰胺酶(ESBLs)大肠埃希菌5年内平均阳性率为40.0%,耐药率趋于平稳,产ESBLs肺炎克雷伯菌5年平均阳性率为17.6%,耐药率逐年增高。铜绿假单胞菌对多种抗菌药物呈逐年升高趋势。检出革兰阳性球菌604株(24.6%),耐甲氧西林金黄色葡萄球菌(MRSA)与耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)5年内平均检出率分别为32.9%和81.3%,未检出耐万古霉素肠球菌(VRE)。检出真菌746株(30.4%),白色假丝酵母菌及光滑假丝酵母菌对抗真菌药高度敏感,热带假丝酵母菌对氟康唑和伊曲康唑耐药率近年来增长较快(>20.0%)。结论该院临床分离病原菌以革兰阴性杆菌为主,近5年来的耐药率呈缓慢升高趋势。定期回顾分析临床分离的主要病原菌分布及其耐药性变迁,有助于临床合理应用抗菌药物和制定耐药菌的防治策略。

Objective To grasp the distribution and drug resistance of the main pathogenic bacteria of the hospital from 2012 to 2016,which provides the basis for the rational application of antimicrobial agents. Methods A retrospective analysis was used to investigated the distribution and drug susceptibility of 2 453 strains of pathogenicity of clinical separation from January 2012 to December 2016. Results The top five clinical pathogens were white pseudo yeast,escherichia coli,klebsiella pneumoniae,coagulase-negative staphylococcus,enterococcus,which were get from a total of 2 453 strains of non-repetitive pathogens that detection of gram-negative bacillus as the main pathogenic bacteria of 1 103 strains （45.0%）,the average positive rate of ESBLs -producing E.coli was 40.0% and it′s drug resistance rate tends to be stable in five years.The average positive rate of ESBLs-producing pneumonia klebsiella bacteria was 17.6%,which drug resistance was increased year by year.The drug resistance of pseudomonas aeruginosa to various antimicrobial agents also was increased year by year.Detection of 604 strains （24.6%） were gram positive coccus,which average detection rate of 32.9 %,81.3% respectively of methicillin-resistantstaphylococcus aureus （MRSA） and methicillin-resistant coagulase negative staphylococcus （MRCNS） within five years.Failure of detection of the vancomycin resistant enterococcus （VRE）.Detection of fungi 746 strains （30.4%）,white and smooth against candida fungus candida mycoderma bacterias drug highly sensitive,the drug resistant rate of tropical candida to fluconazole and itraconazole was increased fastly in recent years （〉20.0%）. Conclusion The gram-negative bacillu were the most in pathogenic bacteria,and which drug resistance rate has increased in the last five years gradually.Regularly retrospective analysis of the distribution and drug resistance changes in the main clinical isolated pathogenic bacteria,which helps clinician to rationally use of antibacterial and decsion of prevention strategy to drug-resistant bacteria.