综合医院不同临床标本病原菌检测结果及耐药性分析

目的分析顺德市第一人民医院临床送检的呼吸道分泌物、中段尿、血液等标本检出的病原菌分布及主要病原菌的耐药性进行分析，为临床合理应用抗生素提供依据。方法对该院2007年6月～2008年12月临床送检的呼吸道分泌物、中段尿、血液标本进行培养分离病原菌，采用VITEK系统进行菌种鉴定，纸片琼脂扩散（K—B）法进行药敏试验。对所得数据进行统计分析。结果三种不同标本分离出病原菌分别为1623株、439株、116株，其菌群分布各不相同。呼吸道分泌物和中段尿分离病原菌以革兰阴性杆菌为主，血液分离病原菌以大肠埃希菌和肺炎克雷伯菌居前列。其它多为葡萄球菌。大肠埃希菌和肺炎克雷伯菌的产ESBLS的检出率分别为40．5％和28．3％；耐甲氧西林金黄色葡萄菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为42．5％和53．2％。革兰阴性菌对亚胺培南、哌拉西林，他唑巴坦、头胞吡肟耐药率较低；MRSA和MRCNS呈多重耐药性，耐药指数明显高于MSSA和MSCNS，未发现耐万古霉素的葡萄球菌，葡萄球菌对呋喃妥因和利福平耐药率较低。结论积极进行病原菌与药敏监测，合理应用抗生素。具有十分重要的意义。

Survey of pathogens of bacteria in various speciemns and drug resistance in an integrated hospital

Objective To investigate the distribution and drug resistance of nosocomial infection pathogens of the respiratory secretion, urine and blood from patients of a general hospital. Methods The pathogens of respiratory secretion, urine and blood were isolated, baterial identification were performed with VITEK system, susceptibility of isolates were tested by Kirby-Bauer method. The data were analyzed. Results There 1 623,439 and 116 strains of pathogen were isolated from three different specimens. The main pathogens of respiratory secretion and urine were gram-negative bacilli,and the major pathogens of blood were E.coli and Klebsiella pneumonia,followed by Staphylococcus aureus. The detection rate of exended-spectrum-β lactamases in E.coli and Klebsiella pneumonia isolates was 40.5% and 28.3%,the constitutional ratio of methicillin-resistant Staphylococcus aureus and methicillin-resistant, coagulase nagative staphylococcus was 42.5% and 53.2%. Resistance rates of gram-negative bacteria to imipenem, piperacillin/tazobactam and cefepime were lower than other antibiotics. MRSA and MRCNS showed multiple drug resistance,The sensitivity gram-positive bacteria to nitrofurantoin and rifampin was higher than other antibiotics. Conclusions Pathogen detection and drug sensitivity test axe vital to rantional use of antibiotics.