某综合医院2013年住院患者病原菌分布及耐药性分析

目的：通过对2013年医院住院患者病原微生物检出情况及其耐药性分析，了解医院病原菌检出趋势，为临床合理用药提供依据。方法回顾性分析2013年1~12月微生物实验室检测标本16456份，对送检标本来源分布、病原菌检出结果、细菌耐药性、监测结果进行分析。结果送检标本来源前三位分别为痰液、血液、分泌物。送检样本中阳性样本3614份，阳检率为21.96%。阳性样本中革兰氏阴性菌占66.19%，革兰氏阳性菌占16.6%，真菌占17.21%。病原菌排名前三位分别为大肠埃希菌、肺炎克雷伯氏菌、白色念珠菌。耐药菌监测前三位及其耐药菌检出率为大肠埃希菌（45.04%）、鲍曼不动杆菌（29.04%）、肺炎克雷伯氏菌（25.68%）。结论医院内病原菌以革兰氏阴性细菌为主，革兰氏阴性细菌对β内酰胺类及β内酰胺酶抑制剂的复方制剂、喹诺酮类甚至碳青霉烯类抗菌药物较为敏感。铜绿假单胞菌对喹诺酮类、氨基糖苷类和碳青霉烯类抗菌药物较敏感。革兰氏阳性球菌对青霉素类、大环内酯类耐药率高达75%~100%，真菌对氟康唑、伊曲康唑、伏立康唑耐药率大于74%。

Distribution and drug resistance of pathogens among patients in a general hospital

Objective To analyze the distribution and drug resistance of pathogens so as to investigate the trend of pathogenic bacteria and provide bases for administration. Methods Retrospective analysis of the distribu-tion, result of test, drug resistance and main pathogenic organism in 16 456 tested samples in 2013. Results The main samples are sputum, blood, and secretion with a positive rate of 21.96%, among which the gram-negative bacte-ria accounted for 66.19%, the gram-positive bacteria accounted for 16.6%, and fungi accounted for 17.21%. The main types of bacteria are E.coli, Klebsiella p, Candida albicans. The top three rates of drug resistant bacteria are E.coli （45.04%）, Acinetobacter baumannii （29.04%） and klebsiella p. （25.68%）. Conclusion Gram-negative bacteria was the main Pathogenic bacteria, which is sensitive toβ-lactams,β-lactamase inhibitor and carbapenems. P aeruginosa is sen-sitive to quinolones, aminoglycosides and carbapenems. The resistant rate of gram positive bacteria to macrolide anti-biotics and penicillin is as high as 75%~100%. Fungus shows high resistance rates to fluconazole, itraconzole and vori-conazole, which were even higher than 74%.