鏡湖醫院主要病原菌分佈及耐藥性分析

Distribution of the main pathogens and antimicrobial resistance in Kiang Wu Hospital

目的晾解本院常見病原菌的分怖和耐藥特點,為經驗性抗菌素治療提供参考。方法對2011~2015年本院细菌培饕標:本分離的病原菌、藥敏試驗結果及耐藥特點進行回顧性分析。結果.2011~2015年本院細菌培餐標本53318例次(扣除重複送檢),分離病原菌16118株(30.2%)。革蘭陰性稈菌7995株(49.6%),革蘭陽性球菌4835株(30.0%),真菌3249株(20.16%),厭氧菌39株(0.24)。格蘭氏陰性稈菌中,大腸稈菌佔34.7%、肺炎克雷伯稈菌佔18.3%、綠膿稈菌佔15.6%、鮑曼不動稈菌佔6.6%。產ESBL s大腸稈菌和肺炎克雷伯捍菌檢出率分別為37.8%和19.8%,對Tazocin,Amikacin,Tienam,Meropenem及Tigecycline高度敏感,耐藥率<5%。銅綠假軍胞菌對Tazocin,Amikacin,Ceftazidime,Cefepime敏感性>90%。常用抗菌素對鮑曼不動稈菌敏感性高,而Tigecycline對泛耐藥菌株保持100%敏感。格蘭氏陽性球菌以金黃色葡萄球菌為主(佔32%).無乳鏈球菌(佔24.2%).白色葡萄球菌佔(11.5%)、糞腸球菌(佔11.5%)。MRSA在普通病房和ICU的檢出率分別為47%和62%,未發現對Vancomycin,Linezolid,cef taroline和Tigecycline耐藥菌株。結論本院临床威染常見致病菌以大腸稈菌.肺炎克雷伯捍菌.綠膿稈菌和金黃色葡萄球菌為主。產ESBLs大腸稈菌.肺炎克雷伯稈菌,綠膿稈菌和MRSA等致病菌的耐藥問題仍較嚴重,必須常規監測病原菌耐藥性變化,指導臨床醫生合理應用抗菌藥物,減少耐藥菌株的產生。

Objective To investigate the distribution of the predominant pathogens and antimicrobial resistance pattern in Kiang Wu Hospital in recent 5 years in order to provide references to guide the empirical antimicrobial therapy for doctors.Methods Retrospective analysis was made on the bacteria distribution and antimicrobial resistance situation in our hospital during the year of 2011 to 2015.Results A total of 16118 non-duplicate clinical isolates were collected from 53318 culture samples during the year of 2011 to 2015.The overall positive isolation rate was 30.2%,of which Gram-negative bacilli and Gram-positive cocci accounted for 49.6%and 30.0%,respectively.In addition,fungi and anaerobic bacteria accounted for 20.2%and 0.2%,respectively.The most common Gram-negative bacilli isolated were Escherichia coli(34.7%),Klebsiella pneumonia(18.3%),Pseudomonas aeruginosa(15.6%)and Acinetobacter baumanni(6.6%).Extended-spectrumβ-lactamase(ESBLs)producing strains accounted for 37.8%and 19.8%in Escherichia coli(34.7%)and Klebsiella pneumonia,respectively.ESBL strains were still highly susceptible to Tazocin,Amikacin,Imipenem,Meropenem and Tigecycline,with an overall resistance rate of<5%.Pseudomonas aeruginosa was highly susceptible to Tazocin,Amikacin,Ceftazidime and Cefepime,with an overall sensitivity rate of>90%.The resistance rates of Pseudomonas aeruginosa to Meropenem and Imipenem were 13.1%and 19.9%respectively.Acinetobacter baumannii has a high sensitivity to antibiotics Imipenem were 13.1%and 19.9%respectively.Acinetobacter baumannii has a high sensitivity to antibiotics commonly used in the treatment of Acinetobacter infection,with an overall resistance rate of 6.3%. e extensively-resistant strains in Acinetobacter baumannii were only sensitivity to Tigecycline. e most common bacteria of the isolated Gram-positive cocci were Staphylococcus aureus(32%),Streptococcus agalactiae(24.2%),Staphylococcus epidermidis(11.5%%)and Enterococcus faecalis(11.5%).Methicillin-resistant strains in S.aureus(MRSA)accounted for an average of 47%(General ward)and 62%(ICU),respectively of all Staphylococcus aureus isolates.No staphylococcal strains were found resistant to vancomycin,linezolid,ceftaroline or tigecycline.Conclusion e extent of drug resistance of Escherichia coli,Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus(MRSA)was under control,but ESBLs producing-strains in Klebsiella pneumoniae and prevalence of extensively-resistant strains in Acinetobacter baumannii continued to show a rising trend in the past ve years.Doctors should understand the pathogen changes and drug-resistance trends to guide clinical therapy.