2014年某教学医院7415例痰培养病原菌分布及药敏分析

目的　调查2014年某教学医院下呼吸道标本首次检出的7415株细菌的类型、科室分布及耐药情况，以指导临床合理用药。方法　应用WHONET5.6软件对7415株细菌进行细菌分布、科室分布和耐药情况分析。结果 7415株细菌前十位以革兰阴性杆菌为主，占总数的80.2%，其中检出率前三位的是铜绿假单胞菌(25.9%)，鲍曼不动杆菌(20.5%)，肺炎克雷伯菌(18.3%);革兰阳性菌占总数7.9 %，其中金黄色葡萄球菌的检出率最高，占6.6%。病原菌的科室分布以急诊ICU最多(29.6%)，其次为神经内科(19.2%)，神经外科(17.2%)。大肠埃希菌对头孢唑林、头孢噻肟、头孢吡肟、环丙沙星、左旋氧氟沙星、莫西沙星、复方新诺明、四环素的耐药率均较高，在73.0%以上,肺炎克雷伯菌和铜绿假单胞菌对氨苄西林、阿莫西林/克拉维酸、氨苄西林/舒巴坦、头孢唑啉、头孢噻肟、环丙沙星、左旋氧氟沙星、莫西沙星、的耐药率较高，耐药率均已超过60.0%。大肠埃希菌与铜绿假单胞菌对碳青霉烯类药物的耐药率都在50%以下，金黄色葡萄球菌对苯唑西林的耐药率为75.4%，而对万古霉素的敏感率则为100%。结论 下呼吸道标本检出菌多集中在重症医学科，多为高水平的多重耐药菌。应当规范抗菌药物的使用，严格各种无菌操作技术，控制多重耐药菌的流行与传播。

The investigation of the 7415 sputum culture results in a teaching hospital of in 2014

Objective To investigate the types, distribution and drug resistance of 7415 strains of bacteria in the lower respiratory tract of a teaching hospital in 2014,and to guide clinical rational drug use. Methods The distribution of bacteria, the distribution and drug resistance of 7415 strains of bacteria were analyzed by WHONET5.6 software. Results The top 7415 strains of bacteria were gram negative bacilli, which accounted for 80.2% of the total, and the top three of positive rate were Pseudomonas aeruginosa(25.9%), Bauman Acinetobacter (20.5%), Klebsiella pneumoniae (18.3%), gram positive bacteria accounted for 7.9%, and the detection rate of Staphylococcus aureus was the highest, accounting for 6.6%. The number of pathogenic bacteria was the most ICU (29.6%), followed by the Department of internal medicine (19.2%), Department of Neurosurgery (17.2%).E. coli to cefazolin, cefotaxime, cefepime, ciprofloxacin and ofloxacin, moxifloxacin, compound new Ming, tetracycline, have higher percentages, in more than 73.0%.Klebsiella pneumoniae and pseudomonas aeruginosa to ampicillin, amoxicillin/clavulanic acid, ampicillin/shu ba jotham, cefazolin, cefotaxime, ciprofloxacin and ofloxacin, moxifloxacin, higher prevalence of resistance,and the resistance is more than 60.0%.E. coli and pseudomonas aeruginosa on carbon penicillium alkene drug resistance are below 50%,and the staphylococcus aureus of benzene Westwood resistant rate is 75.4%, and 100% sensitive to vancomycin rate.Conclusion: Gram-negative bacilli take a major position in respiratory system infection. Having higher resistance to commonly used antibiotics, sensitive antimicrobial drug should be chosen for clinical medicine, and avoide the abuse of antibiotics.