血培养常见菌株的分布及金黄色葡萄球菌耐药性的分析

目的调查同济医院2006年1月至2008年12月血培养中常见非重复分离菌株的构成；分析金黄色葡萄球菌对常用抗菌药物的耐药性。方法采用WHONET5．4软件分析连续3年血培养中的非重复分离菌株的分布；采用K-B纸片法测定金黄色葡萄球菌对常用抗菌药物的敏感性。结果2006年1月至2008年12月共分离细菌1336株，其中革兰阳性球菌占58．5％（781／1336）、革兰阴性杆菌占37．2％（497／1336）、真菌占4．27％（57／1336）。分离的前10位菌株依次为凝固酶阴性葡萄球菌（CNS，40．42％）、大肠埃希菌（13．47％）、肠球菌属（5．54％）、克雷伯菌属（4．94％）、金黄色葡萄球菌（4．34％）、草绿链球菌（4．34％）、真菌（4．27％）、沙门菌属（3．59％）、铜绿假单胞菌（3．29％）、嗜麦芽窄食单胞菌（3．14％）。金黄色葡萄球菌共58株，其中甲氧西林耐药金黄色葡萄球菌（methicillinresistantStaphylococcusoltl-eus。MRSA）占44．8％（26／58）。MRSA对头孢菌素类、氨苄西林／舒巴坦、红霉素、克林霉素、复方新诺明、庆大霉素和左氧氟沙星、磷霉素、利福平耐药率明显高于甲氧西林敏感的金黄色葡萄球菌（methicillin—susceptibleStaphylococcuso,uFeus，MSSA），且差异具有统计学意义（P〈0．001）。未发现对万古霉素和替考拉宁不敏感的菌株。结论本院血培养分离株中，凝固酶阴性葡萄球菌仍占据第一位。金黄色葡萄球菌占分离菌株第五位，其中MRSA检出率较高，且耐药性严重。MRSA病区的分布及耐药谱分析提示可能存在MRSA的克隆传播。

The Distribution of Non-repeated Strains and the Antimicrobial Resistance of Staphylococcus aureus Isolated from Blood Culture

Objective To investigate the distribution of non-repeated strains and the antimicrobial resistance of Staphylococcus aureus isolated from blood culture of Tongji hospital from 2006 to 2008. Methods Data of the non-repeated strains was analyzed by WHONET 5.4 software. Disk diffusion susceptibility test （K-B method） was used to determine the antimicrobial susceptibility of Staphylococcus aureus. Results A total of 1336 clinical isolates was colleted in the three years, including gram-posltive cocci 58.5% （781/1336）,gram-negative bacilli 37.2% （497/ 1336）, and fungus 4.27% （57/1336）. The top ten pathogens were coagulase negative Staphylococcus （CNS, 40.42% ）, Escherichia coli （13.47% ） ,Enterococcus spp. （5.54%）, Klebsiella spp. （4.94%）, Staphylococcus aureus （4.34%）, Streptococcus viridans （4.34%）,fungus （4.27%）,Salmonella spp. （3.59%）,Pseudornonas aeruginosa （3.29%）, Stenotrophomonas maltophilia （3.14%）. About 44.8% of S.aureus were identified as MRSA （26/58）. The resistance of MRSA to Cephalosporins, Ampicil-sulbactam, Erythromyein, Clindamyein, SMZ-TMP, Gentamiein, Levofloxaein, Fosfocina and Rifampicin was high, The resistance rate of MRSA was obviously higher than that of MSSA（P〈0.001 ）. No strain was found to be non-susceptible to Vaneomyein and Teieoplanin. Conclusions Among the non-repeated strains, CNS was still the first place.Staphylococcus aureus ranked fifth, which hint that it was one of the main pathogen of hospital Septicemia.The antimicrobial resistance of S.aureus was severe and the prevalence of MRSA was high in Tongji hospital. There was elonal transmission of MRSA suggested by the distribution of department and the resistance profile.