某院2011—2015年医院感染病原菌分布及耐药性

目的了解某院医院感染病原菌的分布及耐药性特点，为指导临床合理使用抗菌药物和控制医院感染提供理论依据。方法选取2011-2015年该院医院感染病例，统计分析其主要病原菌及耐药性。结果共分离病原菌852株，其中革兰阴性菌458株（53.75%），真菌259株（30.40%），革兰阳性菌135株(15.85%)，居前4位的病原菌分别是肺炎克雷伯菌（159株，18.66%）、白假丝酵母菌（119株，13.97%）、鲍曼不动杆菌（81株，9.51%）、大肠埃希菌（74株，8.69%）。革兰阴性菌从2012年的47.41%上升至2015年的61.57%，真菌从2011年的24.78%上升至2014年的34.45%，2015年为27.95%，革兰阳性菌则从2011年的26.55%下降至2015年的10.48%。大肠埃希菌、肺炎克雷伯菌对亚胺培南、美罗培南耐药率为8.11%～12.58%；鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率最低（23.46%），白假丝酵母菌对氟康唑的耐药率达59.66%，未发现耐万古霉素的革兰阳性菌。结论医院感染的主要病原菌大多为条件致病菌,但耐药情况严峻，在不同年份其病原菌种类和构成均有所区别，需加大力度提高送检率，加强细菌耐药性监测,合理应用抗菌药物。

Distribution and antimicrobial resistance of pathogens causing healthcare associated infection in a hospital in 2011-2015

ObjectiveTo explore the distribution and antimicrobial resistance of pathogens causing healthcare associated infection(HAI) in a hospital, and provide theoretical basis for rational use of antimicrobial agents and control of HAI.MethodsHAI occurred in patients in this hospital between 2011 and 2015 were chosen, distribution of major pathogens causing HAI and antimicrobial resistance were analyzed.ResultsA total of 852 pathogenic strains were isolated, including 458 (53.75%) strains of gram negative bacteria, 259 (30.40%) fungi, and 135(15.85%) gram positive bacteria, the top 4 pathogens were Klebsiella pneumoniae(n=159，18.66%), Candida albicans (n=119，13.97%), Acinetobacter baumannii(n=81，9.51%), and Escherichia coli(n=74，8.69%). Isolation rate of gram negative bacteria increased from 47.41% in 2012 to 61.57% in 2015, fungi increased from 24.78% in 2011 to 34.45% in 2014 (2015 was 27.95%), gram positive bacteria decreased from 26.55% in 2011 to 10.48% in 2015. Resistance rates of Escherichia coli and Klebsiella pneumoniae to imipenem and meropenem were 8.11%-12.58%；Acinetobacter baumannii had the lowest resistance rate to cefoperazone/sulbactam(23.46%)，resistance rate of Candida albicans to fluconazole was up to 59.66%，vancomycin resistant gram positive bacteria was not found.ConclusionThe major pathogens causing HAI are opportunistic pathogens, antimicrobial resistance is serious, the species and distribution varies with different years, it is necessary to enhance specimen detection rate, strengthen the monitoring on pathogen resistance, and use antimicrobial agents rationally.