2003—2008年临床分离病原菌及耐药性的变迁分析

目的：探讨近6年本院临床分离病原菌的构成及耐药性的变化趋势。方法：对2003—2008年住院患者临床标本分离出的29621株病原菌的分布、耐药情况、抗菌药物的用药频度进行统计分析。结果：临床分离的病原菌中革兰阴性（G^-）杆菌，占53．6％（15889／29621），并有逐年上升趋势；革兰阳性（G^＋）球菌，占31．1％（9221／29621），呈逐年下降趋势；真菌检出率无明显增加。葡萄球菌中MRSA检出率为从82．2％降至72．2％；MRCNS检出率波动在83．1％～90．4％。革兰阴性（G^-）杆菌中大肠埃希菌、肺炎克雷伯杆菌中产ESBLs分离率分别从38．9％上升至53．8％和35．2％上升至55．3％，对多数抗菌药耐药率呈上升趋势。产ESBLs检出率和DDDs相关性分析显示：大肠埃希菌、肺炎克雷伯杆菌产ESBLs分离率与三代头孢菌素用药频度呈正相关。结论：临床分离菌耐药率较高，需加强抗感染药的规范应用。

Evolution of clinically isolated pathogens and antibiotic resistance between 2003 and 2008

Objective：To investigate the evolution of clinically isolated pathogens and their antibiotic resistance during the recent 6 years. Methods ：A total of 29621 pathogen strains isolated from clinical samples of in-patients in our hospital between 2003 and 2008 were statistically analyzed for distribution, drug resistance and use of antibiotics. Results： Of the clinically isolated pathogens, Gram-negative （ G^ - ） bacilli accounted for 53.6% （ 15 889/29 621 ） on a year-to-year rise, Gram-positive （G ^＋ ） cocci accounted for 31.1% （9 221/29 621 ） on a year-to-year decline,while the detection rate of fungus was not obviously increased. Among Staphylococcus areus strains, detection rate of MRSA decreased from 82.2% to 72.2% , and that of MRCNS fluctuated between 83.1% and 90.4%. Among Gram-negative bacilli ,ESBLs production by from Escherichia coli and Klehsiella pneumoniae had elevated from 38.9% to 53.8% and from 35.2% to 55.3 % , respectively, with an increasing trend of multi-drug resistance. The analysis of ESBLs detection rate and DDDs revealed a positive correlation between rate of ESBLs production by Eschefichia coli or Klebsiella pneumoniae and DDDs of third-generation cephalosporins. Conclusion： The high prevalence of drug resistance in clinically isolated pathogens suggested a need for rational use of antimicrohial agents.