2009年我院临床常见病原菌分布及耐药性分析

目的分析2009年我院临床常见病原菌的分布及其对常用抗生素的耐药情况,以指导临床合理用药。方法利用V itek-32及ATB自动微生物分析仪对我院2009年送检临床标本的病原菌进行鉴定和药物敏感试验,同时对葡萄球菌、肠球菌、肺炎链球菌、大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌分别进行耐甲氧西林葡萄球菌(MRS)、高水平氨基糖甙类耐药(HLAR)、耐青霉素肺炎链球菌(PRSP)和超广谱β内酰胺酶(ESBLs)的检测。结果 2009年共分离到8 238株病原菌,其中革兰阴性菌4 836株,占58.7%;革兰阳性菌2 364株,占28.7%;真菌1 038株,占12.6%。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌是临床最常见的革兰阴性杆菌。大肠埃希菌和肺炎克雷伯菌产ESBLs株检出率分别为51.0%和32.5%,肠杆菌科细菌对碳青霉烯类、丁胺卡那、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率较低,耐药率在1.1%~39.9%。铜绿假单胞菌对亚胺培南的耐药率为22.0%。葡萄球菌中,耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为49.2%和81.6%,未分离到耐万古霉素葡萄球菌。HLAR肠球菌和VRE的检出率分别为63.5%和5.3%,PRSP的检出率为14.6%。真菌对氟康唑耐药率较高,对其余4种抗真菌药物较敏感。结论 2009年我院临床常见病原菌仍以革兰阴性杆菌为主,病原菌的耐药性明显升高,因此,应加强医院感染病原菌分布及耐药性监测,合理使用抗生素,减少耐药菌株的流行,降低医院感染的发生率。

Pathogens distribution and antimicrobial resistance of clinical isolates:analysis for the year 2009

Objective To investigate the distribution of pathogens and antimicrobial resistance to guide drug treatment in clinic.Methods The identification and antimicrobial susceptibility test of pathogens were detected by Vitek-32 and ATB microbiologic analyzer.Methicillin-resistant staphylococci（MRS）,high-level aminoglycoside resistance（HLAR）,penicillin-resistant Streptococcus pneumoniae（PRSP） and extended spectrum β-lactamases（ESBLs） were detected in Staphylococcus,Enterococcus,Streptococcus pneumonia and gram-negative bacilli,respectively.Results Among 8239 isolates obtained in 2009,Gram-negative bacteria,Gram-positive bacteria and fungi were 58.7%,28.7% and 12.6%,respectively.Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae were predominant in gram-negative bacilli.The ESBLs producing Escherichia coli and Klebsiella pneumoniae were 51.0% and 32.5%,respectively.Isolates of Enterobacteriaceae were relatively sensitive to imipenem,meropenem,amikacin,piperacillin-tazobactam and cefoperazone-sulbactam;the resistance rates were from 1.1% to 39.9%.The rate of imipenem-resistant Pseudomonas aeruginosa was 22.0%.Methicillin-resistant S.aureus（MRSA） and methicillin-resistant coagulase-negative staphylococci（MRCNS） accounted for 49.2% and 81.6% respectively,and No vancomycin resistant isolate was detected.63.5% and 5.3% of enterococci isolates were HLAR and vancomycin-resistant enterococci（VRE）.PRSP accounted for 14.6% among all the isolates of S.pneumonia.Fungus isolates were highly resistant to fluconazole while susceptible to other four antifungal agents.Conclusion Gram-negative bacilli isolates were predominant in clinic.Bacterial resistance increases significantly in recent years.The surveillance of bacterial resistance and rational antibiotic use could reduce production and dissemination of drug resistant strains.