2012年医院常见病原菌分布及耐药性分析

目的 分析永州市中心医院临床标本病原菌的构成及耐药性,为医院感染防治及临床合理使用抗菌药物提供依据. 方法 对本院送检至细菌室的标本进行分离培养,其中血培养为美国BD公司BACTEC9120全自动血培养仪及配套血培养瓶,采用法国生物梅里埃VITEK-2 Compact全自动微生物分析系统及配套的鉴定和药敏卡进行测定.结果 分离到4 913株病原菌,其中革兰阴性（G-）杆菌3 046株,占62.00％,革兰阳性（G＋）球菌1 375株,占27.99％,真菌499株,占10.01％.产ESBLs大肠埃希菌和肺炎克雷伯菌总共801株,占这两种菌的55.3％,肠杆菌科细菌对亚胺培南、厄他培南、哌拉西林/他唑巴坦、头孢替坦和阿米卡星敏感,对氨苄西林耐药率最高,铜绿假单胞菌对氨苄西林/舒巴坦最敏感,鲍曼不动杆菌对阿米卡星最敏感.金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌（MRSA）检出率为55.00％,敏感的药有替加环素、万古霉素、呋喃妥因、喹努普汀/达福普汀和利奈唑胺. 结论 2012年本院分离的病原菌以G-杆菌为主,常见病原菌耐药严重,需引起临床高度重视,并加强细菌耐药监测,合理用药,减少多重耐药菌的产生,降低医院感染率.

Analysis on Distribution and Drug Resistance of Common Pathogenic Bacteria in Yongzhou Central Hospital in 2012

Objective To analyze the distribution and drug resistance of pathogenic bacteria in clinical specimens from Yongzhou Central Hospital,and provide a basis for prevention and treatment of nosocomial infections and rational use of antimicrobial agents.Methods Pathogenic bacteria isolated from the clinical specimens in Yongzhou Central Hospital were cultured with BD BACTEC 9120 automated blood culture system and matching blood culture bottle.Pathogen identification and drug susceptibility test were performed using bioMerieux VITEK-2 Compact automatic microorganism analyzer.Results A total of 4,913 strains of pathogenic bacteria were isolated,including 3,046 strains of Gram-negative bacteria （62％）,1,375 strains of Gram-positive cocci （27.99％）,and 499 strains of fungi （10.01％）.Altogether 532 strains of ESBLs-producing Escherichia coli and 269 strains of ESBLs-producing Klebsiella pneumoniae were detected,accounting for 67.0％ of Escherichia coli and 41.2％ of Klebsiella pneumoniae,respectively.Enteric bacilli were sensitive to imipenem,ertapenem,piperacillin/tazobactam,cefotetan and amikacin,but were highly resistant to ampicillin.Pseudomonas aeruginosa was highly sensitive to ampicillin/sulbactam.Acinetobacter baumannii was highly sensitive to amikacin.Among Staphylococcus aureus,the detection rate of methicillin-resistant Staphylococcus aureus （MRSA） was 55.00 ％,which was sensitive to tigecycline,vancomycin,nitrofurantoin,quinupristin/dalfopristin and linezolid.Conclusions Gram-negative bacteria are the main clinical isolates in Yongzhou Central Hospital in 2012,and antibiotic resistance of the common pathogens is serious.More attention should be paid to the surveillance of bacterial resistance and rational use of drugs in clinical practice so as to reduce the generation of multi-drug-resistant bacteria and decrease the incidence rate of nosocomial infections.