2011~2013年山东省聊城市人民医院病原菌分布与耐药性研究

The analysis of pathogenic bacterial distribution and drug resistance in Liao Cheng People′s Hospital from 2011 to 2013

目的了解该院临床病原菌分布状况,为医院感染的控制和临床用药提供科学依据。方法收集2011~2013年该院临床送检各类标本,对标本种类、分布和耐药性进行回顾性分析。使用VITEK-2Compact全自动细菌鉴定及配套的药敏系统进行细菌鉴定和药敏试验。采用WHONET5.4软件统计数据并应用SPSS17.0统计软件分析菌株的临床分布和耐药性特征。结果 2011~2013年共收到标本71 929例,检出病原菌13 277株,检测阳性率为18.5%;排在前3位的阳性标本分别为痰液(62.8%)、分泌物及脓液(11.3%)、血液(10.3%)。革兰阴性菌为主要病原菌,占73.3%,革兰阳性菌占25.0%;排在前5位的病原菌依次为大肠埃希菌(21.1%)、铜绿假单胞菌(14.8%)、鲍曼不动杆菌(12.5%)、肺炎克雷伯菌(12.2%)、金黄色葡萄球菌(11.04%)。2011~2013年临床分离的革兰阴性菌对广谱青霉素类、除第4代以外的头孢菌素类、喹诺酮类及氨基糖苷类药物均表现出不同程度的耐药性。金黄色葡萄球菌对青霉素、红霉素及克林霉素耐药率高达80%以上,对苯唑西林耐药率逐年降低,肠杆菌科细菌对碳青霉烯类仍最敏感,敏感率均在98%以上,但2011~2013年肠杆菌科出现了耐碳青酶烯类肠杆菌。结论 2011~2013年该院阳性标本以痰液为主;革兰阴性菌是主要病原菌,多重耐药明显;大肠埃希菌为优势菌株,真菌感染率逐年增加;临床与医院感染科应提高警惕,加强细菌耐药监测,提高合理使用抗菌药物水平。

Objective To know the distribution of pathogenic bacteria in the hospital,and to provide scientific evidence for controlling hospital infection and clinical medication.Methods Samples of the hospitalized patients and the data of bacteria culture and isolation in the hospital were collected and statistically analysed retrospectively from January 2011 to December 2013.Bacterial identification and drug sensitivity test were carried out by using VITEK 2 Compact automated bacterial identification and drug sensitive system.The clinical distribution and drug resistance characteristics of the strains were analyzed by using WHONET5.4 and SPSS 17.0 software.Results In the hospital,71 929 specimens were received from 2011 to 2013totally,the detection rate of pathogenic bacteria was 18.5%.Sputum(62.8%),secretions and pus(11.3%),blood(10.3%)were the top three types of specimens which had larger positive numbers.Gram negative bacteria are the main kind of pathogenic bacteria in the hospital,accounting for73.3%.Gram positive bacteria accounted for 25.0%.E.coli(21.1%),Pseudomonas aeruginosa(14.8%),Acinetobacter baumannii(12.5%),Klebsiella pneumoniae(12.2%)and Staphylococcus aureus(11.04%)were the top five pathogenic bacteria.The drug resistance of the isolates were as follows.Gram-negative bacteria showed resistance of different extents to broad-spectrum penicillins,quinolones,cephalosporins except for the 4th generationsand and aminoglycosides.Over 80% Staphylococcus aureus showed resistance to penicillin,erythromycin and clindamycin,but the rate to Oxacillin were decreasing year by year.Enterobacteria were still most sensitive to carbapenems with a sensitive rate over 98.6%.However,the emergence of Carbapenem-resistent enterobacteria from 2011 to 2013was worthy of clinical attention.Conclusion The type of positive specimens were mainly sputum.Gram negative bacteria are the main pathogenic bacteria,and have obvious multi-drug resistance.E.Coli is the superiority strains,fungal infection rate are increasing year by year.Doctors and hospital infection controlling department should pay attention to the monitoring of bacterial resistance and improve the rational use of antimicrobial drugs.