1240株临床分离菌株耐药性监测

目的：分析临床分离菌株构成特点及耐药性，为临床用药提供参考依据。方法采用K‐B纸片扩散法或自动化仪器法进行抗菌药物敏感试验，按CLSI2013年标准，采用WHONET5．6软件进行统计分析。结果2013年1～12月共分离临床细菌1240株，其中革兰阳性菌406株，占32．7％，革兰阴性菌834株，占67．3％；分离菌株前5位依次为大肠埃希菌、克雷伯菌属、凝固酶阴性葡萄球菌、金黄色葡萄球菌、肺炎链球菌；分离标本构成前5位依次是痰液、尿液、血液、分泌物、大便；葡萄球菌属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）检出率分别为17．1％和74．7％，未发现万古霉素、奎奴普丁／达福普汀、替加环素和利奈唑胺耐药株；肠球菌属细菌未发现万古霉素耐药株；肠杆菌科细菌对碳青霉烯类抗菌药物（亚胺培南、厄他培南）保持较好的敏感性，均大于85％，大肠埃希菌、克雷伯菌属细菌（肺炎克雷伯菌和产酸克雷伯菌）中产超广谱β‐内酰胺酶（ESBLs）株分别为56．7％、18．6％；铜绿假单胞菌对亚胺培南耐药性为11．9％；不动杆菌属对亚胺培南耐药性为19．0％。结论该院住院患者感染部位以呼吸道为主，临床应重视病原菌培养标本送检；临床分离病原菌与重庆市耐药监测网统计前5位细菌及耐药状况基本一致。

Antimicrobial resistance monitoring of 1 240 clinically isolated bacteria

Objective To investigate the bacterial distribution and resistance of clinical isolates ,so as to provide basis for the clinical medication .Methods The drug susceptibility testing was performed by Kirby‐Bauer method or automated system .The re‐sults were analyzed by WHONET 5 .6 referring to the breakpoints of CLSI 2013 .Results Of 1 240 clinical iso1ates ,the gram‐posi‐tive cocci and gram‐negative bacteria accounted for 32 .7% and 67 .3% respectively .The top five of isolated strains were Escherichia coli ,Klebsiella spp ,coagulase negative staphylococci ,Staphylococcus aureus ,Streptococcus pneumonia;the first five of isolated spec‐imens constitute followed by sputum ,urine ,blood ,secretions and stool .The average prevalence of methicillin‐resistant strains in S . aureus (MRSA) and coagulase‐negative Staphylococcus (MRCNS)was 17 .1% and 74 .7% ,respectively ;no vancomycin ,teicoplanin or linezolid‐resistant strains were found;no vancomycin‐resistant strains were found in Enterococcus spp;Enterobacteriaceae was still highly susceptible to imipenem and meropenem (> 85% );extended spectrum beta‐lactamases(ESBLs) producing strains ac‐counted for 56 .7% of Escherichia coli ,and accounted for 18 .6% of Klebsiella pneumonia;the drug resistance rates of Pseudomonas aeruginosa to imipenem was 11 .9% .The drug resistance rates of Acinetobacter spp to imipenem was 19 .0% .Conclusion The main infection site of patients in this hospital is respiratory tract and attention should be paid to docimastic sample .The top five clinical i‐solates and drug resistance are roughly the same with the results of Chongqing drug resistance monitoring net .