深圳市某医院细菌耐药性情况的调查分析

目的调查深圳市龙岗区第二人民医院2010年1～9月细菌分布及耐药情况,为合理使用抗菌药物提供实验室依据。方法收集微生物实验室细菌培养及药敏试验报告,汇总排名前3位的革兰氏阳性球菌对十种抗菌药物的耐药情况及排名前3位的革兰氏阴性杆菌对十种抗菌药物的耐药情况及本院六种常见多重耐药菌的耐药情况,进行回顾性调查。结果共分离出1044株病原菌,其中革兰氏阳性菌299株（28.6%）,革兰氏阴性菌497株（47.6%）,真菌248株（23.8%）。六种常见多重耐药菌按构成比依次为：MRSE（占41.9%）、产ESBLs的大肠埃希菌（占28.7%）、产ESBLs的肺炎克雷伯菌（占11.8%）、产ESBLs阴沟肠杆菌（占2.9%）、MRSA（占2.2%）、泛耐药的鲍曼不动杆菌PDR-AB（占0.7%）。MRSE分离率达80.3%,MRSA分离率仅7.7%,未发现万古霉素耐药的葡萄球菌。大肠埃希菌和肺炎克雷伯菌的产超广谱β-内酰胺酶的代表株占ESBLs的90%,EC-ESBLs目前对亚胺培南、阿米卡星全部敏感;哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢西丁对其保持良好的抗菌活性,平均耐药率为10%～20%,但对三代头孢、广谱青霉素类药物呈现出高度耐药。产ESBLs肺炎克雷伯菌对各种抗生素的总体耐药率远低于大肠埃希菌。泛耐药的鲍曼不动杆菌PDR-AB建议选用哌拉西林/他唑巴坦、头孢哌酮/舒巴坦联合多粘菌素或阿米卡星治疗。结论规范、持续性的细菌耐药监测活动对临床合理用药具有长期深远的影响。

Investigation and analysis of bacterial drug resistance in a hospital in Shenzhen

Objective To investigate the bacteria distribution and drug resistance in the Second People Hospital of Longgang District,Shenzhen from Juan to Sep,and lay the theoretical foundation for reasonable application of antibiotics.Methods A retrospective investigation were carried out among the top 3 kind of G+coccus and G-bacillus according to the data of bacterial culture and antimicrobial susceptibility test from microbiological laboratory.Results 1 044 pathogenic bacteria were isolated,the percent rates of G+bacteria,G-bacteria,and fungus were 28.6%(299 cases),47.6%(497cases) and 23.8%(248 cases) respectively.The percent rates of the 6 kind of common multiple resistant bacteria MRSE,E.coli producing ESBLs,Klebsiella pneumonia producing ESBLs,Enterobacter cloacae producing ESBLs,MRSA,Pan-resistant Acinetobacter baumannii PDR-AB were 41.9%,28.7%,11.8%,2.9% and 2.2% respectively.The isolation rate of MRSE were 80.3% while MRSA were 7.7%.Staphylococcus resistant to vancomycin was undetected.The proportion of E.coli and Klebsiella pneumonia with extended spectrum β-Lactamases was 90.0%.Imipenem and amikacin was highly sensitive to EC-ESBL,piperacillin/tazobactam,cefoperazone/sulbactam,cefoxitin,were sensitive(Drug resistance rate ≤10%~20%),while third generation cephalosporin,broad-spectrum penicillin were highly resistant.The overall drug resistance rate of Klebsiella pneumonia producing ESBLs was lower than E.coli.Piperacillin/tazobactam,cefoperazone/sulbactam combining bacillosporinor amikacin were proposal for Pan-resistant Acinetobacter baumannii PDR-AB.Conclusion Continually taking drug resistance test produces a significant effect on rational drug applying.