医院临床分离病原菌抗菌药物敏感性分析

目的分析该院2012年临床分离病原菌的分布和耐药性，为临床正确诊断和合理使用抗菌药物提供科学依据。方法病原菌的分离按照《全国临床检验操作规程》第3版进行，采用梅里埃公司的VITEK2COMPACT全自动微生物分析仪对菌株进行鉴定和抗菌药物敏感性检测，结果依据2012年CLSIM100-S22折点判读。结果从20319例标本中共分离病原菌6018株，所占比例排前5住的依次为鲍曼不动杆菌（19．14％）、大肠埃希菌（15．84％）、铜绿假单胞菌（14．57％）、肺炎克雷伯菌（14．29％）和金黄色葡萄球菌（5．62％）。标本来源于痰（47．02％）、无菌部位标本（22．04％）、血液（20．50％）、尿液（8．24％）和粪便（2．20％）。耐甲氧西林金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌的检出率分别为34．91％、77．18％和85．71％。未检出对万古霉素、利奈唑烷和替加环素耐药葡萄球菌、屎肠球菌和粪肠球菌。产超广谱p内酰胺酶大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌的检出率分别为60．76％、29．53％、40．63％。肠杆菌科细菌对碳青酶烯类抗菌药物保持高度敏感性，大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、黏质沙雷菌、产气肠杆菌、产酸克雷伯菌、奇异变形杆菌对亚胺培南的敏感率分别为98．43％、95．58％、97．89％、100．00％、100．00％、93．75％、100．00％。非发酵菌对碳青酶烯类抗菌药物的敏感性较低，鲍曼不动杆菌、铜绿假单胞菌对亚胺培南的敏感率分别为35．42％和59．52％。结论该院临床分离菌以鲍曼不动杆菌、大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌和金黄色葡萄球菌为主，细菌的耐药性较为严重，必须采取有效措施加以控制。．

Distribution and drug susceptibility of the pathogenic bacteria isolated from clinical specimens

Objective To explore the distribution and drug resistance of clinical isolated pathogens so as to provide scientific ba- sis for the correct diagnosis and rational use of antibiotics. Methods The isolation of pathogens was performed according to the Na- tional Clinical Laboratory Procedures. The identification and drug susceptibility of clinical isolates was carried out using the VITEK2 Compact system,and the results were determined based on the interpretation of CLSI 2012 break point. Results A total of 6 018 strains of pathogens were isolated from 20 319 specimens, among which Acinetobacter baumannii （19.14%）,Escherichia coli （ 15.84 % ）, Pseudomonas aeruginosa （ 14. 57 % ）, Klebsiella pneumoniae （ 14. 29 %）, Staphylococcus aureus （ 5. 62 % ） were the first five most common pathogens. The bacteria were mainly isolated from sputum（47.02% ）, other fluids（22.04 % ）, blood（20.50 % ）, u- rine（8.24% ） and stool（2.20 % ）. The methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus haemolyticus were 34. 91%, 77. 18% and 85. 71%, respectively. No strains of vancomycin-, linezolid- and tigecycline-resistant Staphylococci,Enterococcus faecium and Enterococcus faecalis were detected. The detection rates of the Escherichia coli ,Klebsiel- la pneumoniae and Klebsiella oxytoca producing extended β-1actamases （ESBLs） were 60.76%, 29.53% and 40.63%, respective- ly. Enterobacteriaceae remained at a high sensitivity to carbapenems, though imipenem-resistant Enterobacteriaceae have occurred. The non-fermenting bacteria were highly resistant to carbapenems. The imipenem-sensitive rates of Acinetobacter baumannii and Pseudomonas aeruginosa were 35.42%and 59.52%, respectively. Conclusion Acinetobacter baumannii, Escherichia coli, Pseudo- monas aeruginosa ,Klebsiella pneumonia and Staphylococcus aureus were the five most common pathogens. Bacterial resistance sit- uation is still serious and more effective measures should be taken to control it.