某医院临床分离病原菌分布及耐药性监测

Distribution and drug resistance monitoring of clinically isolated pathogenic bacteria in a hospital

目的分析某医院2018年1月1日—2019年12月31日临床分离病原菌的分布及耐药情况,为临床合理用药提供依据。方法采用法国生物梅里埃公司的VitekⅡ全自动微生物分析仪进行菌株鉴定,药敏试验采用纸片扩散法,E试验检测万古霉素对葡萄球菌属的最低抑菌浓度(minimum inhibitory concentration, MIC),数据分析采用WHONET 5.6软件和SPSS 20.0软件。结果 2018年1月1日—2019年12月31日共分离细菌2 183株,其中革兰阴性菌1 386株(63.49%)、革兰阳性菌624株(28.58%)、真菌173株(7.92%)。标本来源以呼吸道为主。医院各主要科室的病原菌分布不同。除鲍曼不动杆菌外,大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌均对碳青霉烯类抗菌药物耐药率较低。未检出耐替考拉宁、利奈唑胺、万古霉素的葡萄球菌和肠球菌。多重耐药菌检出率高,其中耐碳青霉烯类鲍曼不动杆菌最高(χ^(2)=6.011,P<0.05)。结论应针对重点病原菌、重点科室、重点患者加强医院感染控制;此外,仍需加强细菌耐药性监测,以了解细菌耐药变化趋势,指导临床合理用药,减少多重耐药菌的发生及传播。

Objective To provide the basis for clinical rational use of drugs by analyzing the distribution and drug resistance of clinically isolated pathogenic bacteria in a hospital from January 1,2018 to December 31,2019.Methods Strain identification was carried out with the VitekⅡ automatic microbial analyzer from France BioMerieux, an antimicrobial susceptibility test(AST) was implemented by the disc diffusion method(Kirby-Bauer),E test was implemented to detect the minimum inhibitory concentration(MIC) of vancomycin against Staphylococcus,and the data analysis was carried out by means of WHONET 5.6 and SPSS 20.0 software.Results A total of 2 183 strains of bacteria were isolated within 2 years, there were 1 386 Gram-negative bacteria(63.49%);624 Gram-positive bacteria(28.58%),and 173 fungi(7.92%).The specimens were mainly sourced from the respiratory tract.The pathogenic bacteria were differently distributed in major departments of the hospital.Escherichia coli,Pseudomonas aeruginosa,and Klebsiella pneumoniae were found to have drug resistance rate against carbapenems.The resistance of Staphylococcus or Enterococcus against teicoplanin, linezolid or vancomycin was not detected.The positive rate of multi-drug resistant bacteria was high, and the carbapenem’s resistance to Acinetobacter baumannii was the highest(χ^(2)=6.011,P<0.05).Conclusion Nosocomial infection control should be strengthened for critical pathogens, key departments, and key patients.Additionally, it remains being necessary to tighten the monitoring on bacterial resistance to understand the trend of bacterial resistance, guide clinical rational use of drugs, and slow the occurrence and spread of multi-drug-resistant bacteria.