医院感染常见病原菌耐药性变迁及对策

目的了解临床常见病原菌耐药性变化趋势,提出应对策略. 方法提取我院2000年1月～2003年12月4年中,自住院患者标本中分离数量占前4位的主要致病菌耐药性资料,采用API生化鉴定系统进行鉴定,并严格按美国临床试验室标准化委员会(NCCLS)制定标准用Kirby-Bauer法进行药物敏感性实验. 结果 4年中分离数量占前4位的表皮葡萄球菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌1 290 株;耐药性分析显示:4种临床常见致病菌耐药率均呈逐年上升趋势,表皮葡萄球菌对16种抗菌药物中的9种耐药率均>70.5%,对万古霉素的耐药率最低(3.1%),其次为呋喃妥因(21.5%);大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对18种抗菌药物中的10种耐药率>40%,仅对亚胺培南、头孢他啶的耐药率<22.0%,主要病原菌对部分抗菌药物产生多重耐药. 结论继续加强细菌耐药性监测,采取有效的应对措施,延缓耐药菌的产生和蔓延.

Vicissitudes of Drug Resistance and Intervention in Hospital

OBJECTIVE To study the trend of antimicrobial resistance to pathogenic bacteria in hospital and carry out intervention. METHODS Bacteria isolated from patients in our hospital, from Jan 2000 to Dec 2003, were detected by API identified tests (API Inc, France). Bacterial drug susceptibility test was performed on strains using standard Kirby Bauer method in accordance with guidelines of NCCLS. RESULTS A total of 1 290 strains of pathogens were isolated in the past four years, the most common pathogens of them were Staphylococcus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Under our surveillance the drug resistance rate of the most common pathogens appeared increasing trend. Staphylococcus showed resistant rates >70 5% to 9 kinds of antibiotics, 3 1% to vancomyin, 21 5% to nitrofurantoin; E. coli, K. pneumoniae, P. aeruginosa showed resistant rates >40% to 10 kinds of antibiotics, 22 0% to imipenem and ceftazidime. mainly pathogenic bacteria were multi resistant to some antibiotics. CONCLUSIONS Prevalence of antibiotic resistance bacteria is effectively postponed by appropriate methods including monitoring of resistant bacterial strains and effective intervention strategy.