2008-2010年临床分离病原菌分布及耐药性分析

目的 分析医院2008-2010年的细菌分布及耐药性,为临床合理选用抗菌药物提供依据.方法 采用回顾性调查方法,运用x2检验对医院2008年1月-2010年12月门诊住院患者各类标本中分离的病原菌进行统计和耐药分析.结果 肠杆菌科前3位为大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌,对亚胺培南耐药率最低；3年产超广谱β-内酰胺酶( ESBLs)大肠埃希菌检出率分别为56.4％、60.2％、62.3％,产ESBLs肺炎克雷伯菌分别为55.2％、52.7％、50.1％；非发酵菌前3位为铜绿假单胞菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌,鲍氏不动杆菌和铜绿假单胞菌对多黏菌素的耐药率最低,嗜麦芽寡养单胞菌对磺胺甲噁唑/甲氧苄啶耐药率最低；革兰阳性球菌前3位是金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌,对万古霉素和氯霉素耐药率最低,耐甲氧西林金黄色葡萄球菌(MRSA)的分离率3年分别为35.2％、37.1％和29.1％.结论 碳青霉烯类仍然是肠杆菌科细菌活性最高的药物；万古霉素、氯霉素对革兰阳性球菌始终保持高活性;非发酵菌耐药率较高,需关注多药耐药菌的出现；产ESBLs的大肠埃希菌分离率逐年增加,值得关注.

Distribution and antibiotic resistance of pathogenic bacteria causing nosocomial infections from 2008 to 2010

OBJECTIVE To investigate the distribution and antibiotic resistance of pathogenic bacteria from 2008 to 2010,and to provide reference for rational use of antibiotics in clinical practice.METHODS With the retrospective survey method,the pathogens isolated from various specimens obtained from outpatients from Jan.2008 to Dec.2010 were performed for statistical analysis,and the drug resistance was analyzed by χ2 test.RESULTS The top 3 Enterobacteriaceae bacteria were Escherichia coli,Klebsiella pneumoniae and Klebsiella oxytoca which had the lowest resistance rates to imipenem,The resistance rates to imipenem of ESBLs-producing E.coli and K.pneumoniae in three years were 56.4%,60.2%,62.3% and 55.2%,52.7%,and 50.1%,respectively.The top 3 nonfermenting bacteria were Pseudomonas aeruginosa,Acinetobacter baumannii and Stenotrophomonas maltophilia,and the resistance rates to polymyxin of A.baumannii and P.aeruginosa were the lowest,the resistance rate to sulfamethoxazole/trimethoprim of S.maltophilia was the lowest.The top 3 gram-positive cocci were Staphylococcus aureus,Staphylococcus epidermidis and Enterobacter faecalis which had the lowest resistance rates to vancomycin and chloromycin,the isolation rates of methicillin-resistant S.aureus(MRSA)during the three years were 35.2%,37.1%,and 29.1%,respectively.CONCLUSION Carbapenems still maintain the highest bacterial activity against Enterobacteriaceae;vancomycin and chloromycin always maintain high activity against gram-positive cocci;the resistance rates of nonfermenting bacteria are relatively high,and the emergence of multidrug-resistant bacteria deserves our attention;the isolation rate of ESBLs-producing E.coli is increasing year by year,which is worthy of concern.