6 536株临床分离菌分布特点及耐药分析

目的调查沈阳军区总医院临床常见分离病原菌分布及抗菌药物耐药性3年间的变迁。 方法抗菌药物敏感试验参照CLSI 2012年、2013年和2014年版进行并判断结果，使用WHONET 5.5软件及SPSS 17.0软件进行数据统计分析。 结果按患者首次分离菌株进行统计分析，收集时间为2012至2014年的每年4月1日至9月30日。共收集临床分离菌共6 536株，其中，革兰阴性菌5 390株，占82.47%；革兰阳性菌1 146株，占17.53%。革兰阴性菌中分离率排列前3位的分别是鲍曼不动杆菌（占21.02%）、肺炎克雷伯菌（占20.38%）和铜绿假单胞菌（占19.09%）。耐甲氧西林金黄色葡萄球菌（MRSA）检出率为41.56%。3年来耐万古霉素的屎肠球菌分别占2.6%、5.3%和1.3%。肠杆菌科细菌对碳青霉烯类抗菌药物耐药率低于1.5%，肺炎克雷伯菌的耐药率低于大肠埃希菌。近3年来，鲍曼不动杆菌对包括亚胺培南在内的大多数监测药物耐药率均超过60.0%，而铜绿假单胞菌对大多数药物则保持了较高的抗菌活性。 结论加强细菌耐药性监测，及早发现耐药机制，及时掌握细菌耐药变迁，以指导临床合理选择抗菌药物。

Analysis of antibiotic resistance and clinical distribution of 6 536 isolated stains

ObjectiveTo investigate the distribution and prevalence of antimicrobial susceptibility in the General Hospital of Shenyang Military Command during 2012-2014. MethodsThe results were analyzed according to the Clinical Laboratory Standards Institute (CLSI) breakpoints (2012, 2013 and 2014), and all data were analyzed by WHONET 5.5 and SPSS 17.0 software. ResultsTotal of 6 536 isolates were collected from clinic every year from April 1st to September 30th during 2012-2014. Among which, there were 5 390 (82.47%) Gram-negative bacterial isolates and 1 146 (17.53%) Gram-positive bacterial isolates. The top three Gram-negative bacterial isolates were Acinetobacter baumannii (21.02%), Klebsiella pneumoniae (20.38%) and Pseudomonas aeruginosa (19.09%). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 41.56% from Staphylococcus aureus. All the isolates with vancomycin resistant Enterococcus faecium (VRE) accounted for 2.6%, 5.3% and 1.3% from 2012-2014, respectively. The rate of carbapenem-resistant Enterobacteriaceae (CRE) was < 1.5%, and Klebsiella pneumoniae resistant rate was lower than that of Escherichia coli. Acinetobacter baumannii had higher resistance to imipenem, with the resistant rate of 60.0% increase from 2012 to 2014, and the isolates of Pseudomonas aeruginosa were still highly susceptible to most surveillance drugs. ConclusionsSurveillance of bacterial resistance was important and valuable for understanding the resistant pattern change in local hospital and rational selection of antimicrobial agents.