842例医院感染患者病原菌的菌种分布及耐药性

Distribution and drug resistance of pathogenic bacteria in 842 patients with nosocomial infection

目的 观察842例医院感染患者病原菌的菌种分布及其耐药性。方法 天津市第三中心医院2019年住院患者中发生医院感染的患者842例,采集标本后使用VITEK-2Compact全自动微生物分析系统进行菌株检测,采用佰珞仪器法、最低抑菌浓度法和琼脂纸片扩散法进行药敏试验。结果 842例医院感染患者共分离出病原菌499株,其中革兰阴性菌338株、革兰阳性菌117株、真菌33株、支原体11株。338株革兰阴性菌中,肺炎克雷伯菌107株、鲍曼不动杆菌69株、大肠埃希菌68株、铜绿假单胞菌37株、其他革兰阴性菌57株,其中耐碳青霉烯大肠埃希菌4株、耐碳青霉烯肺炎克雷伯菌47株。117株革兰阳性菌中,屎肠球菌43株、金黄色葡萄球菌23株、表皮葡萄球菌17株、粪肠球菌17株、其他革兰阳性菌17株。33株真菌中,白假丝酵母菌16株、曲霉菌6株、其他真菌11株。大肠埃希菌对氨苄西林、头孢呋辛、庆大霉素、环丙沙星、复方新诺明、左旋氧氟沙星的耐药率均超过30%;肺炎克雷伯菌对氨苄西林、头孢呋辛、呋喃妥因的耐药率均超过30%;铜绿假单胞菌对替卡西林、庆大霉素、头孢吡肟的耐药率均超过20%;鲍曼不动杆菌对多数临床应用的抗生素普遍耐药,仅对头孢哌酮/舒巴坦、替加环素、多黏菌素的耐药率低。革兰阳性菌均对万古霉素、替考拉宁、利奈唑胺敏感;其中金黄色葡萄球菌对庆大霉素、环丙沙星、米诺环素、利福平、呋喃妥因、四环素、头孢唑啉、复方新诺明的耐药率均低于30%;表皮葡萄球菌对庆大霉素、米诺环素、利福平、呋喃妥因、四环素的耐药率均低于30%;屎肠球菌对临床常用抗菌药物普遍耐药,耐药率均超过30%;粪肠球菌对氨苄西林、青霉素G、呋喃妥因的耐药率均低于30%。结论 842例医院感染患者的主要病原菌为肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌等革兰阴性菌,对氨苄西林、头孢呋辛、庆大霉素等耐药率较高。检出的屎肠球菌、金黄色葡萄球菌等革兰阳性菌均对万古霉素、替考拉宁、利奈唑胺敏感。

Objective To observe the distribution and drug resistance of pathogenic bacteria in 842 patients with nosocomial infection.Methods Nosocomial infection occurred in 842 patients in Tianjin Third Central Hospital in2019.After collecting the specimens,the VITEK-2 Compact automatic microbiological analysis system was used for bacterial strain detection.The drug susceptibility test was performed by the tablet diffusion method.Results A total of 499 cases of pathogenic bacteria were detected from 842 patients with nosocomial infections.Among them,338 cases were Gram-negative bacteria,117 cases were Gram-positive bacteria,33 cases were Fungi,and 11 cases were Mycoplasmas.Among the 338 strains of Gram-negative bacteria,there were 107 strains of Klebsiella pneumoniae,69 strains of Acinetobacter baumannii,68 strains of Escherichia coli,37 strains of Pseudomonas aeruginosa,and 57 strains of other Gram-negative bacteria,of which,4 strains were carbapenem-resistant Escherichia coli and 47 strains were carbapenem-resistant Klebsiella pneumonia.Among the 117 strains of Gram-positive bacteria,43 strains were Enterococcus faecium,23 were Staphylococcus aureus,17 were Staphylococcus epidermidis,17 were Enterococcus faecalis,and 17 were other Gram-positive bacteria.Among the 33 strains of fungi,there were 16 strains of Candida albicans,6 strains of Aspergillus,and 11 strains of other Fungi.Escherichia coli had high resistance rates to ampicillin,cefuroxime,gentamicin,ciprofloxacin,compound trimethoprim,and levofloxacin,and the resistance rates exceeded 30%;Klebsiella pneumoniae had high resistance rates to ampicillin,cefuroxime and nitrofurantoin,and the resistance rates exceeded 30%;Pseudomonas aeruginosa had high resistance rates to ticarcillin,gentamicin,and cefepime,and the drug resistance rates exceeded 20%;Acinetobacter baumannii was generally resistant to most clinically used antibiotics,and only kept low resistance rates to cefoperazone,sulbactam,tigecycline,and polymyxin.Gram-positive bacteria were all sensitive to vancomycin,teicoplanin,and linezolid;among them,Staphylococcus aureus was resistant to gentamicin,ciprofloxacin,minocycline,rifampicin,nitrofurantoin,tetracycline,cefazolin,and compound sulfamethoxazole tablets,and all the resistance rates were lower than 30%;the resistance rates of Staphylococcus epidermidis to gentamicin,minocycline,rifampicin,nitrofurantoin,and tetracycline were lower than 30%;Enterococcus faecium was generally resistant to clinically used antibiotics,with a re sistance rate of more than 30%;the drug resistance rates of Enterococcus faecalis to ampicillin,penicillin G,and nitrofurantoin were low,and all were lower than 30%.Conclusions The main pathogenic bacteria in 842 patients with nosocomial infection were Gram-negative bacteria such as Klebsiella pneumoniae,Acinetobacter baumannii,Escherichia coli,etc.The drug resistance rates to ampicillin,cefuroxime,and gentamicin were high.The detected Gram-positive bacteria such as Enterococcus faecium and Staphylococcus aureus were all sensitive to vancomycin,teicoplanin and linezolid.