我院2001-2010年医院感染常见致病菌分布及耐药变迁分析

目的:了解我院院内感染的致病菌临床分布及其耐药情况,以指导临床合理用药。方法:回顾性收集我院2001-2010年检验科保存的确诊感染患者的各类标本的微生物检验报告单,所有菌株均采用K-B纸片琼脂扩散法进行药敏试验。结果:2001-2010年临床共分离菌株11942株,其中革兰阳性(G+)菌2582株,革兰阴性(G-)菌7289株,真菌2071株。分离排名前10位为大肠埃希菌(Eco)1306株,占分离菌株的10.9%;白色假丝酵母菌(Cal)1275株,占分离菌株的10.7%(占真菌总数的61.6%);铜绿假单胞菌(PA)1270株,占分离菌株的10.6%;肺炎克雷伯菌(Kp)1061株;鲍曼不动杆菌(Ab)870株;金黄色葡萄球菌(SA)678株;阴沟肠杆菌(Ecl)418株;表皮葡萄球菌(SE)335株;粪/屎肠球菌(Efa/Efm)311株。PA从2006年起明显呈现上升趋势,检出率排名第1位,真菌检出率也呈上升趋势,Cal现居第2位。Eco对大多数抗菌药物的耐药性均高于Kp(Kp对呋喃妥因耐药率高于Eco),Eco对氨曲南耐药率由18.8%升至74.3%,对头孢他啶由8.7%升至74.1%,应引起临床足够重视。Kp对大多数抗菌药物耐药率都控制在50%以下,耐药率有不同程度的增加。Ecl仅对亚胺培南、阿米卡星敏感度较高。PA、Ab对头孢曲松、头孢噻肟均高度耐药(>90%)应引起重视。SA、SE对青霉素、红霉素、克林霉素高度耐药。Efm对利福平、高浓度庆大霉素、环丙沙星、青霉素、氨苄西林耐药性明显高于Efa且高度耐药,对四环素耐药性明显低于Efa。结论:我院临床感染致病菌的分布及耐药具有一定的地域特征。致病菌的分布变迁由PA、Ab、Cal的检出量上升引起,G-菌检出率(73.8%)较全国整体水平偏高。G-菌对头孢吡肟、头孢他啶耐药率偏高,对阿米卡星、庆大霉素、头孢噻肟等耐药率略低于其他地区;G+菌对克林霉素耐药率明显高于全国整体耐药率。

Distribution and Drug Resistance Vicissitude of the Common Pathogenic Bacterias in Our Hospital from 2001 to 2010

OBJECTIVE：To investigate the distribution and drug resistance of common pathogenic bacterias in our hospital in order to guide clinical rational use of drugs.METHODS：Microbiological examination report of samples from patients diagnosed infection were collected from laboratory section of our hospital during 2001-2010.Bacterial susceptibility test was carried out according to a unified protocol using K-B agar tape diffusion method.RESULTS：A total of 11 942 clinical isolates were collected from 2001 to 2010,of which there were 7 289 strains of Gram negative（G-） organisms,2 582 strains of Gram positive（G＋） cocci and 2 071 strains of fungus.The top 10 isolated pathogenic bacterias were 1 306 strains of E.coli （Eco,10.9%）,1 275 strains of Candida albican （Cal,10.7%,61.6% of all fungus）,1 270 strains of P.aeruginosa （PA,10.6%）,1 061 strains of K.pneumoniae （Kp）,870 strains of Acinetobacter baumannii （Ab）,678 strains of Staphylococcus aureus （SA）,418 strains of Enterobacter cloacae （Ecl）,335 strains of Staphylococcus epidermidis （SE）,311 strains of E.faecalis/E.faecium （Efa/Efm）.Since 2006 PA showed a rising trend and took the top place in term of detection rate,followed by Cal,and fungus also showed ascendant trend and took the third place.The resistance rates of Eco to most sorts of antimicrobial agents were higher than Kp （except furantoin）.The drug resistance of Eco to aztreonam rose from 18.8% to 74.3% and that to ceftazidime from 8.7% to 74.1%.Great importance should be paid to it.Drug resistance of Kp to most of antibacterials was maintained below 50%,it increased to different extent.Ecl were only highly sensitive to imipenem and amikacin.PA and Ab were highly resistant to ceftriaxone and cefotaxime （〉90%）.SA/SE were highly resistant to penicillin,erythromycin and clindamycin.The resistance rates of Efm to rifampicin,high concentration of gentamicin,ciprofloxacin,penicillin and ampicillin were significantly higher than Efa,but that to tetracycline was significantly lower than Efa.CONCLUSION：The distributions and drug resistance of clinical infection pathogenic bacteria have a certain regional characteristic in our hospital.The distribution of the pathogenic bacteria is changed by the detection rates of PA,Ab and Cal.The detection rate of G-（73.8%） is higher than national level.The resistance rates of G-strains to cefepime and ceftazidime are high,and to amikacin,gentamicin and cefotaxime are lower than other regions.The resistance rates of G＋ strains to clindamycin is higher than the national level.