2016年中国医科大学附属盛京医院泌尿外科病原菌的分布及耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria in Shengjing Hospital of China Medical University in 2016

目的了解2016年1—12月中国医科大学附属盛京医院泌尿外科住院患者感染的主要病原菌分布及其耐药性,为临床感染患者抗生素的合理应用提供参考依据。方法回顾性分析2016年1—12月中国医科大学附属盛京医院泌尿外科住院患者感染的主要病原菌分布及其耐药性。结果共分离出495株病原菌,其中革兰阴性菌有312株,占63.03%,主要为大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌和铜绿假单胞菌;共分离出革兰阳性菌180株,占36.37%,主要为粪肠球菌、屎肠球菌和表皮葡萄球菌;共分离出真菌3株,占0.6%。大肠埃希菌对氨苄西林、哌拉西林以及头孢唑啉的耐药率均大于80%,对厄他培南、美罗培南的耐药率较低。肺炎克雷伯菌对头孢噻肟、头孢唑啉、氨苄西林、哌拉西林的耐药率均在70%以上,而对厄他培南、美罗培南的耐药率为0。奇异变形杆菌对氨苄西林、呋喃妥因、复方新诺明、四环素的耐药率在70%以上,未检出对阿米卡星、厄他培南、美罗培南、哌拉西林/他唑巴坦、头孢他啶、头孢替坦、妥布霉素、亚胺培南耐药的菌株。铜绿假单胞菌对氨苄西林、氨苄西林/舒巴坦、厄他培南、头孢曲松、头孢替坦、头孢唑林及呋喃妥因等抗生素耐药率为100%;未检出对氨曲南、美罗培南、哌拉西林、头孢吡肟、头孢他啶耐药的菌株。粪肠球菌对克林霉素、喹努普汀/达福普汀的耐药率为100%,未检出对呋喃妥因、氯霉素、替考拉宁、替加环素、万古霉素耐药的菌株。屎肠球菌对红霉素、克林霉素、利福平和青霉素G的耐药率为100%,未检出对利奈唑胺和替加环素耐药的菌株。表皮葡萄球菌对青霉素G的耐药率为100%,未检出对利奈唑胺、喹努普汀/达福普汀、替加环素、呋喃妥因和万古霉素耐药的菌株。结论中国医科大学附属盛京医院泌尿外科患者感染病原菌中分离率最高的为革兰阴性菌,临床医师应根据药敏结果指导抗生素的应用,有效控制感染并且延缓耐药菌的产生。

Objective To understand the distribution and drug resistance of pathogenic bacteria in hospitalized patients from January to December 2016 in Department of Urology Surgery of Shengjing Hospital of China Medical University, and to provide reference for reasonable application of antibiotics. Methods A retrospective survey was conducted to analyze the distribution and drug resistance of pathogenic bacteria in hospitalized patients from January to December 2016 in Department of Urology Surgery of Shengjing Hospital of China Medical University. Results Total 495 strains of pathogens were isolated, in which Gram-negative bacteria were 312 strains（63.03%）, and main of them were Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. Gram-positive bacteria（180 strains） accounted for 36.37%, and main of them were Enterococcus faecalis, E. faecium, and Staphylococcus epidermidis. Fungi were 3 strains（0.6%）. The resistant rates of E. coli against ampicillin, piperacillin, and cefazolin were above 80%, while the resistant rate of E. coli against ertapenem and meropenem was low. The resistant rates of K. pneumoniae against cefotaxime, cefazolin, ampicillin, and piperacillin were above 70%, while the resistant rates of K. pneumoniae against ertapenem and meropenem were 0. The resistant rates of P. mirabilis against ampicillin, macrodantin, trimethoprim/sulfamethoxazole, and tetracycline were above 70%. While there was no P. mirabilis resistant to amikacin, ertapenem, meropenem, piperacillin/tazobactam, ceftazidime, cefotetan, tobramycin, and imipenem detected. The resistant rates of P. aeruginosa against ampicillin, ampicillin/sulbactam, ertapenem, ceftriaxone, cefotetan, cefazolin, and macrodantin were 100%. While there was no P. aeruginosa resistant to aztreonam, meropenem, piperacillin, cefepime, and ceftazidime detected. The resistant rates of E. faecalis against clindamycin and quinupristin/dalfopristin were 100%. While there was no E. faecalis resistant to macrodantin, chloromycetin, teicoplanin, tigecycline, and vancomycin detected. E. faecium was resistant to erythrocin, clindamycin, rifampicin, and penicillin G with the resistant rate of 100%, while was completely sensitive to linezolid and tigecycline. The resistant rate of S. epidermidis against penicillin G was 100%. While there was no S. epidermidis resistant to linezolid, quinupristin/dalfopristin, tigecycline, macrodantin, and vancomycin detected. Conclusion Gram-negative bacilli were the main pathogens causing infections in Department of Urology Surgery of Shengjing Hospital of China Medical University. The clinician should make treatment plan according to the results of drug susceptibility to guide the application of antibiotics, and effectively control the infections and delay the emerging of drug-resistant bacteria.