2009-2011年老年科感染病原菌及其耐药性分析

目的：了解我院2009—2011年老年科常见感染病原菌分布和耐药情况，为临床合理用药提供依据。方法：对2009年1月-2011年12月期间送检的老年科病房患者标本的病原菌进行统计分析，药敏试验采用纸片扩散法（KB法），试验结果判断参照美国临床实验室标准化协会（CLSI）标准（2007年版），应用SPSS13．0统计软件包进行数据分析。结果：从1986份送检的标本中分离出311株病原菌株，革兰阳性菌30株，占9．6％；革兰阴性菌176株，占56．6％；真菌105株，占33．8％。金黄色葡萄球菌全部为耐甲氧西林金黄色葡萄球菌，未发现耐万古霉素葡萄球菌。鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌的检出率（分别为30．5％，9．0％和9．0％）占革兰阴性菌的前3位，且鲍曼不动杆菌为泛耐药，对碳青霉烯类的耐药率在65％以上。白色假丝酵母菌检出率（19．0%）是真菌中最高的，对常用抗真菌药均敏感。结论：老年科病房细菌耐药情况不容忽视，鲍曼不动杆菌的多重耐药性已十分严重，其耐药性可能与其产生的碳青霉烯酶有关。对第三代和第四代头孢菌素以及碳青霉烯类药物的使用应严格掌握适应证。

Distribution of pathogenic bacteria and analysis of drug resistence in elderly wards from 2009 to 2011

Objective：To investigate the distribution of common pathogenic bacteria and changes in drug resistance in elderly patient wards, so as to provide a basis for rational use of drug. Methods：The dise-diffusion method （KB） was used for determination of sensitivity. Data of common pathogenic bacteria were collected from inpatients in elderly wards from January 2009 to February 2011 in Ruijin Hospital. The test results were determined according to the standard of American national committee for clinical laboratory standards （2007 version ）. Data were analyzed by SPSS 13.0. Results： Three hundreds and eleven pathogenic strains were isolated from 1 986 speci- mens. There were 30 strains of Gram positive bacteria （9.6%）, 176 strains of Gram negative bacteria （56.6%）, and 105 strains of fungi （33.8%）. All of Staphylococcus aureus was found to be methicillin resistant Staphylococcus aureus （MRSA）. Vancomycin resistant Staphylococcus aureus was not found. Detection rate of Acinetobacter baumanii, Pseudomonas aeruginosa and Escherichia coli was higher among all Gram negative bacteria（respectively 30.5%, 9.0% and 9.0%）. Acinetobacter baumanii was multi-drug resistant, and resistance rate against carbapenem was as high as 65%. The detection rate of Candida albicans （19.0%） was highest among fungi, also it was sensitive to common antifungal agents. Conclusions：Bacterial drug resistance in elderly ward can not be ignored. It is serious that Acinetobacter baumanii is resistant to multiple antibiotics. The emergence of drug resistance maybe related to carbapenemase production. Rational use of antibiotics, especially the third and fourth generations of cephalosporins and carbapenems, and it is important to strictly observe the indication.