4380株医院感染病原菌的临床分布及耐药性分析

目的了解4 380株医院感染病原菌的临床分布及其耐药性。方法对重庆市急救医疗中心住院患者的标本按常规进行病原菌分离、鉴定和抗菌药物敏感性试验,结果用WHONET5.6软件进行分析。结果医院感染检出率前5位的科室为神经外科、神经内科、创伤科、肿瘤科和中心重症监护病房;7 326例临床送检标本中,分离到4 380株病原菌,检出率约为59.8%,其中革兰阴性杆菌占75.3%(3 300/4 380),革兰阳性球菌占19.0%(831/4 380),真菌占5.7%(249/4 380),排名前10位病原菌依次为:铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、白色念珠菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌属、阴沟肠杆菌、洛菲不动杆菌。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为49.1%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为81.2%,均未检出对糖肽类耐药的葡萄球菌,产超广谱β-内酰胺酶(ESBLs)阳性的大肠埃希菌检出率为58.9%,ESBLs阳性肺炎克雷伯菌检出率为28.9%。结论多种因素致患者免疫力低下,是条件致病菌引起医院感染的主要原因;病原菌以革兰阴性杆菌为主,其中铜绿假单胞菌上升尤为明显,真菌感染比例也有明显上升趋势。肠杆菌科细菌对碳青霉烯酶类、阿米卡星和哌拉西林/他唑巴坦等抗菌药物耐药率较低,铜绿假单胞菌和鲍曼不动杆菌呈现多重耐药趋势。

Clinical distribution and antimicrobial resistance analysis of 4 380 pathogenic bacteria in nosocomial infection

Objective To understand clinical distribution and antimicrobial resistance analysis of 4 380 pathogenic bacteria in nosocomial infection.Methods In 2011 the specimens of patients in the class 3A comprehensive hospital were performed by pathogen isolation,identification and antimicrobial susceptibility test according to the routine detection,the result was analyzed by using WHONET 5.6 software.Results The hospital infection rate ranked in the top five departments was neurosurgery,internal medicine,trauma,oncology and ICU;In the 4 380 pathogenic bacterial strains which were isolated from 7 326 clinical specimen,the detection rate of about 59.8%.The gram negative bacilli accounted for 75.3%（3 300/4 380）,gram positive cocci accounted for 19.0%（831/4 380）,the fungi was 5.7%（249/4 380）.The top 10 pathogenic bacteria were as follows：Pseudomonas aeruginosa,Klebsiella pneumoniae,Bauman Acinetobacter,Escherichia coli,Candida albicans,coagulase-negative staphylococci,Staphylococcus aureus,Enterococcus,Enterobacter cloacae and Acinetobacter lwoffii.Methicillin-resistant Staphylococcus aureus（MRSA） positive rate was 49.1%,methicillin resistant coagulase negative staphylococcus（MRCNS） detection rate was 81.2%.Not detected on the glycopeptide resistance in Staphylococcus aureus,extended-spectrum beta-lactamases（ESBLs） of Escherichia coli positive detection rate was 58.9%,ESBLs positive Klebsiella pneumoniae detection rate was 28.9%.Conclusion A variety of factors resulting in patients with low immunity,is conditional pathogenic bacteria caused the main reason of hospital infection;The main pathogen is gram-negative bacilli,including Pseudomonas aeruginosa which is particularly obvious rise,the proportion of fungal infection also has the obvious rise trend.Enterobacteriaceae to carbapenems,amikacin and piperacillin/tazobactam antibiotic resistance rate is relatively low,which shows a trend of multidrug resistance in pseudomonas aeruginosa and acinetobacter bauman.