综合性医院2010-2016年痰培养病原菌分布及细菌耐药性分析

Distribution and resistance patterns of pathogens isolated from sputum between 2010 and 2016 in a general hospital

目的分析南京医科大学第一附属医院2010—2016年痰培养病原菌分布及其耐药性,为临床医生抗感染治疗提供依据。方法选取2010年1月至2016年12月南京医科大学第一附属医院临床痰标本分离菌株,同一患者分离的相同菌种仅第一株菌纳入统计。所有菌株均经Vitek2compact全自动微生物分析系统或API细菌鉴定系统鉴定。药敏判断标准按照当年的美国实验室标准化协会文件。结果 2010-2016年,痰标本分离到的病原菌主要为鲍曼不动杆菌(4 922株,21.3%)、肺炎克雷伯菌(3 329株,14.4%)、白色念珠菌(3 051株,13.2%)、铜绿假单胞菌(2 947株,12.7%)以及金黄色葡萄球菌(1 763株,7.6%)。各类病原菌对本院常用抗菌药物的耐药率自2012年起呈逐年下降趋势。鲍曼不动杆菌对常见抗菌药物耐药率基本高于50.0%。肺炎克雷伯菌对氨基糖苷类、部分第3、4代头孢菌素、β-内酰胺类/酶抑制剂耐药率均较低。铜绿假单胞菌对临床常见抗菌药物的耐药率基本低于50.0%,但对氨曲南的耐药率相对偏高。耐甲氧西林金黄色葡萄球菌所占比例从2010年的88.7%(236/266)降至2016年的64.0%(181/283),对大多数抗菌药物的耐药率在50.0%以上,对利奈唑胺敏感率极高,暂未发现对万古霉素、替考拉宁耐药的金黄色葡萄球菌。结论我院院内感染控制措施初见成效;对于多重耐药鲍曼不动杆菌感染患者,应及时送检痰标本,选择敏感抗菌药物;碳青霉烯类药物仍可作为治疗多重耐药肺炎克雷伯菌感染的首选;糖肽类抗菌药物及利奈唑胺目前是治疗耐甲氧西林金黄色葡萄球菌感染的有效抗菌药物。

Objective To analyze the distribution and resistance patterns of pathogens isolated from sputum between 2010 and 2016 in a general hospital and provide references for clinical anti-infection therapy. Methods Between January 2010 and December 2016, all strains isolated from sputum in the First Affiliated Hospital of Nanjing Medicial University were identified by Vitek2compact automatic microbial analysis system or API bacterial identification system. One strain of the predominant bacteria was counted in each patient. Criteria of drug sensitivity was based on the documents of Clinical and Laboratory Standards Institute. Results Pathogens isolated from sputum mainly included Acinetobacter baumannii（4 922,21.3%）, Klebsiella pneumoniae（3 329,14.4%）, Candida albicans（3 051,13.2%）, Pseudomonas aeruginosa（2 947,12.7%） and Staphylococcus aureus（1 763,7.6%）. Resistance rates of all kinds of pathogens to commonly used antibiotics showed gradual decline since 2012. The resistance rates of Acinetobacter baumannii to common antibiotics were basically higher than 50.0%. Klebsiella pneumoniae showed low resistance rates to aminoglycosides, the 3rd and 4th generation cephalosporins and β-lactam/enzyme inhibitors. The resistance rates of Pseudomonas aeruginosa to common antibiotics were basically lower than 50.0%; but it showed a relatively high resistance to aztreonam. The proportion of methicillin resistant Staphylococcus aureus decreased from 88.7%（236/266） in 2010 to 64.0%（181/283） in 2016; its resistance rates to most antibiotics were higher than 50.0%; its sensitivity to linezolid was high. No Staphylococcus aureus resistant to vancomycin or teicoplanin was found. Conclusion sInfection control measures have made progress in our hospital. It is important to choose effective antimicrobials according to susceptibility test when encountering a patient infected with multi-drug resistant Acinetobacter baumannii. Carbapenems are the first choice in treatment of multi-drug resistant Klebsiella pneumoniae. Glycopeptide antibiotics and linezolid are preferred in treatment of methicillin resistant Staphylococcus aureus infection.