861株多药耐药菌耐药表型回顾性分析

目的 了解医院多药耐药菌(MDROs)的分布及流行情况.方法 收集医院2006年1月-2010年12月住院患者各类标本中分离出的非重复菌株资料,以WHONET5.4软件进行数据分析.结果 23 405份标本中检出病原菌6779株,检出阳性率为29.0％,其中革兰阳性菌704株占10.4％、革兰阴性菌4480株占66.1％、真菌1750株占25.8％；检出MDROs 861株,占12.7％,其中,产ESBLs细菌307株、耐碳青霉烯类肠杆菌科细菌(CRE)18株、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS) 137株、耐甲氧西林金黄色葡萄球菌(MRSA) 127株、耐碳青霉烯类鲍氏不动杆菌(CRAB) 103株、多药耐药铜绿假单胞菌(MDRPA) 72株、泛耐药铜绿假单胞菌(PDRPA)19株及耐万古霉素肠球菌(VRE)2株;主要来源于下呼吸道457株占53.1％、尿液152株占17.7％、脓性分 泌物150株占17.4％、血液56株占6.5％,MDROs在ICU检出率最高占21.7％,其次为脑外科占10.7％、呼吸科占9.1％、肿瘤科占8.9％.结论 MDROs耐药表型中以产ESBLs细菌、MRCNS、MRSA为主；MDROs在下呼吸道、尿液、脓性分泌物标本中检出率较高,在ICU、脑外科、呼吸科、肿瘤科,MDROs流行情况严重.

Retrospective analysis of resistance phenotypes of 861 strains of multidrug-resistant bacteria

OBJECTIVE To investigate the phenotypes and prevalence of multidrug-resistant organisms(MDROs).METHODS Data of non-repeating bacteria obtained from various specimens of the inpatients between Jan 2006 and Dec 2010 were collected and analyzed by WHONET 5.4 software.RESULTS A total of 6779(29.0%) strains of pathogens were isolated from 23 405 clinical specimens,of which 704(10.4%) strains were gram-positive bacteria,4480(66.1%)strains were gram-negative bacilli,1750(25.8%) strains were fungi.Of the 861(12.7%)strains of isolated MDROs,there were 307 strains of ESBLs-producing bacteria,18 strains of CRE,137 strains of MRCNS,127 strains of MRSA,103 strains of CRAB,72 strains of MDRAP,19 strains of PDRPA and 2 strains of VRE.Pathogens were mainly isolated from lower respiratory tract(475 strains,53.1%),urine(152 strains,17.7%),pus and secretions(150 strains,17.4%)and blood(56 strains,6.5%).The detection rate of MDROs was the highest in ICU(21.7%),followed by neurosurgery department(10.7%),respiratory department(9.1%),and oncology department(8.9%).CONCLUSION ESBLs-producing bacteria,MRCNS,and MRSA are the major resistance phenotypes of MDRO;MDRO are mainly isolated from lower respiratory tract,urine and pus secretion.The prevalence of MDROs is very high in ICU,neurosurgery department,respiratory department,and oncology department.