3 063株病原菌分布及耐药性监测分析

目的 监测我院3年间主要病原菌分布及耐药性．指导临床合理使用抗生素。方法 从2000年1月～2002年12月我院患者血液、尿液和痰标本中分离的病原菌．采用纸片扩散法监测抗生素耐药性。结果 3年间从主要标本中共分离3063株病原菌，革兰阳性球菌27．0%,革兰阴性杆菌56．7％,真菌4．8％；病原菌列前8位的菌种依次为大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、表皮葡萄球菌、粪肠球菌、金黄色葡萄球菌、屎肠球菌。耐甲氧西林金黄色葡萄球菌(methicillin-resistance staphylococcus aureus，MRSA)、耐甲氧西林表皮葡萄球菌(MRS epidermidis,MRSE)分离率分别为58．3％、62．9％．葡萄球菌对万古霉素敏感性最好．其次是头孢哌酮／舒巴坦、头孢唑啉、头孢他啶．耐药率依次为3．9％、23．4％、26．5％;大肠埃希菌对亚胺培南的耐药率最低2．1％，对其他抗生素耐药率较低的依次有头孢哌酮舒巴坦、头孢曲松、头孢他啶。耐药率分别为15．0％、21．9％、26．8%，大肠埃希菌产超广谱β-内酰胺酶株(extended-spectrum β-lactamases，ESBLs)分离率为26．0％．铜绿假单胞菌中多重耐药株明显增多，对亚胺培南的耐药性持续增高．已达29．9％。结论 临床医师应密切关注本地区的病原菌分布及耐药性特点．合理应用抗生素。

DISTRIBUTION AND ANTIBIOTIC RESISTANCE OF 3 063 STRAINS PATHOGENS

ObjectiveTo investigate distribution and antibiotic resistance of main pathogens in three years for reasonable clinical use of antibiotic drugs. MethodsFrom January 2000 to December 2002, pathogens were isolated from sputum,urine and blood of our in-hospital patients.Bacterial susceptibility testing was carried out with Kirby-Bauey method. ResultsAltogether 3 063 strains of pathogens were isolated from major samples in three years.Gram-positive cocci, gram-negative bacilli and yeast accounted for 27.0 %, 56.7 % and 4.8 %, respectively. Most common pathogens were E.coli,P.aeruginosa,A.baumannii,K.pneumoniae,S.epidermidis,E.faecalis,S.aureus,E.faecium.The isolations of methicillin-resistance staphylococcus aureus(MRSA) and MRS epidermidis(MRSE) were 58.3 %, 62.9 % .The antibiotic remaining the most active against S.epidermidis was vancomycin, followed by ceftazidime/sulbactam( 3.9 %),cefazolin( 23.4 %),caftazidime( 26.5 %),that against E.coli was imipenem( 2.1 %),ceftazidime/sulbactam( 15.0 %),ceftriaxone( 21.9 %),caftazidime( 26.8 %).The multiple resistance P.aeruginosa was increasing. ConclusionDoctors should pay more attention to the detection and antibiotic resistance ,which is helpful to select antibiotic correctly.