肠杆菌科细菌医院感染调查及耐药性分析

An Investigation of Nosocomial Infection and Analysis of Drug Resistance on Enterobacteriaceae

目的了解我院肠杆菌科细菌医院内感染情况及临床特点,为临床治疗提供参考依据。方法回顾性分析2016年1月~2017年8月我科临床分离的肠杆菌科细菌的临床分布特点、院内感染与耐药情况。结果在820株肠杆菌科细菌中,大肠埃希菌446株(54.39%),肺炎克雷伯菌158株(19.27%),阴沟肠杆菌91株(11.09%),产气肠杆菌47株(5.73%),其他种类肠杆菌科细菌78株(9.51%)。从痰液中分离出380株(46.34%)占比最大,其次是尿液183株(22.32%)、支气管灌洗液63株(7.68%)。大肠埃希菌对氨苄西林、哌拉西林、四环素、头孢唑啉和复方新诺明有较高耐药率,分别为93.05%(415/446)、84.75%(378/446)、83.18%(371/446)、74.89%(334/446)和73.09%(326/446);阴沟肠杆菌对亚胺培南、美罗培南、阿米卡星的耐药率最低(<9.89%)。结论肠杆菌科细菌医院内的感染以大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌为主,对常用抗菌药物呈现不同程度耐药,而对碳青霉烯类最敏感,其次是阿米卡星,但碳青霉烯类药已出现耐药株,故应加强对肠杆菌科细菌耐药性的监测,以指导临床合理使用抗菌药,控制医院感染的发生。

Objective To have some insight into the nosocomial infection and clinical characteristics of Enterobacteriaceae bacteria in our hospital so as to provide a reference for clinical treatment.Methods Clinical distribution,nosocomial infection and drug resistance of clinical isolates of Enterobacteriaceae bacteria in our department from January 2016 to August 2017 were retrospectively analyzed.Results A total of 820 strains of Enterobacteriaceae bacteria were isolated from various samples,including 446 strains of Escherichia coli (54.39%),158 strains of Klebsiella pneumoniae (19.27%),91 strains of Enterobacter cloacae (11.09%),47 strains of Enterobacteriaceae aerogenes (5.73%) and 78 strains of other types of Enterobacteriaceae (9.51%).There were 380 strains were isolated from sputum (46.34%),followed by 183 strains isolated from urine (22.32%) and 63 strains isolated from broncholavage (7.68%).The Escherichia coli has high resistance rates to Ampicillin,Piperacillin,Tetracycline,Cefazolin and Chemitrim,which are 93.05%(415/446),84.75%(378/446),83.18%(371/446),74.89%(334/446) and 73.09%(326/446) respectively.The resistance rate of Enterobacteriaceae have the lowest resisitence rate to imipenem,meropenem and amikacin (<9.89%).Conclusion Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae are the main nosocomial infections of Enterobacteriaceae.They are resistant to commonly used antibiotics in varying degrees and most sensitive to Carbapenems,followed by Amikacin.However,Carbapenemshaveappeared resistant strains.Therefore,the surveillance of drug resistance of Enterobacteriaceae bacteria should be strengthened to guide the rational use of antibiotics in the clinic and control the occurrence of nosocomial infections.