2017年甘肃医学院附属医院951株医院感染病原菌分布及耐药性分析

目的 通过分析甘肃医学院附属医院2017年1 - 12月医院感染病原菌谱及药敏试验结果，为医院合理使用抗生素来控制医院感染提供依据。方法 采用VITEK 2 Compact全自动微生物鉴定药敏分析仪对送检标本进行鉴定和药敏试验，进而对分离的951株病原菌分布及耐药性进行分析；走访和了解医院抗生素用药情况。结果 2017年经上报确认并统计的医院感染患者共送检标本1 263份，培养阳性标本854份，阳性率为67.6%；共分离951株病原菌（主要来自痰标本），以骨科和呼吸内科居多。标本分离率位于前4位的病原菌中最多的是大肠埃希菌（221株），占分离菌株的23.2%，其中产超广谱β - 内酰胺酶（Extended - Spectrum Beta - Lactamase, ESBLs）菌株104株，占大肠埃希菌的47.1%；最少的是铜绿假单孢菌（54株），占整个分离菌株的5.7%。大肠埃希菌及肺炎克雷伯菌对氨苄西林的耐药率大于90%，铜绿假单胞菌对亚胺培南的耐药率已达29.6%，未发现耐万古霉素的金黄色葡萄球菌。结论 医院感染病原菌具有较强的耐药性,并且分布存在差异，多重耐药菌比例较高。医院应科学分析和掌握感染病原菌分布特点及耐药性情况,指导临床精准合理选择抗菌药物,减少医院感染的发生。

Distribution and antimicrobial resistance of 951 strains of pathogens causing nosocomial infection in the Affiliated Hospital of Gansu Medical College in 2017

Objective To provide the basis for using antibiotic to control and treat such infections, we analyze the distribution and drug resistance of nosocomial pathogens in a Grade 3A hospital of Gansu from January to December in 2017. Methods We analyze the pathogen examination results of nosocomial infection cases in 2017. VITEK 2 Compact was used to identify bacteria and conduct drug sensitive test. We also visit doctors and related department staff to check and understand the antibiotic use in the hospital. Results 1263 microbiological specimens of patients with nosocomial infection were sent for pathogenic detection in 2017, 854(67.6%) of which were isolated pathogens. A total of 951 pathogens were isolated. The most frequent bacteria of top 4 pathogenic bacteria were Escherichia coli(221 strains), accounting for 23.2% of the total isolates. 104 strains of which were ESBLs-producing bacteria, accounting for 47.1% of Escherichia coli. The least frequent bacteria were Pseudomonas aeruginosa(54 strains), accounting for 5.7% of the total isolates. The resistance rate of Escherichia coli and Klebsiella pneumoniae to ampicillin was more than 90%, and the resistance rate of Pseudomonas aeruginosa to imipenem was 29.6%. No vancomycin-resistant Staphylococcus aureus was found. Conclusion Nosocomial infection pathogens have strong drug resistance, and their distribution is different. It is necessary for hospital to analyze and master that distribution characteristic and drug resistance of the pathogenic bacteria of nosocomial infection, instruct the clinically precise and rational selection of antibacterial drugs to reduce the occurrence of nosocomial infection.