非痰标本临床主要病原菌分布及药物耐药性分析

目的了解分析非痰标本主要病原菌分布特点及抗菌药物耐药特性，为临床合理使用抗菌药物提供参考依据。方法对2011年1月~2012年12月从临床非痰标本中分离鉴定出的1859株常见病原菌及药敏结果进行回顾性分析和总结。结果2011～2012年非痰标本检出病原菌共1859株，分离率达前5位的分别是大肠埃希菌、白色念珠菌、金黄色葡萄球菌、屎肠球菌和光滑念珠菌。两年间非痰标本送检率逐年上升。耐甲氧西林金黄色葡萄球菌检出率为28．85％，耐甲氧西林凝固酶阴性葡萄球菌检出率〉80％；大肠埃希菌产ESBLS检出率为53．3％，肺炎克雷伯菌产ESBLs检出率为35．4％。两年间多数抗菌药耐药现象依然严重，但部分抗菌药耐药率变迁呈平稳水平，甚至出现了2012年部分抗菌药较2011年的耐药率下降。但肠杆菌科中奇异变形杆菌对亚胺培南耐药率〉75％，鲍曼不动杆菌和铜绿假单胞菌对碳氢霉烯类耐药率均呈逐年上升。屎肠球菌对万古霉素耐药率高达25％，葡萄球菌未出现耐万古霉素株，白假丝酵母菌对5种抗真菌药耐药率平均〈10％。结论非痰标本中细菌耐药现象普遍，两年间比较主要病原菌对部分抗菌药物的耐药率变迁呈下降趋势，医务人员应坚持做好监测分析、总结及管理抗菌药物工作。

Analysis of Distribution and Drug Resistance of Main Clinical Pathogens from Non-Sputum Specimens

Objective To investigate the distribution and drug resistance of main clinical pathogens from non- sputum specimens in order to provide optimistic clinical therapy. Methods To review and analyze the drug susceptibility and 1 859 common pathogenic strains isolated from non-sputum specimens retrospectively. Results A total of 1 859 isolates were collected from the non-sputum specimens during January 2011 and December 2012. Top five isolates were Escherichia toll, Candiada albicans, S. aureus, E. faecium and Candida glabrata. During the two years,the pathogenic sample submission rate was rising gradually. The detection rate of methicillin-resistant Staphylococcus aureus （MRSA） was 28.85%, Methicillin-resistant coagulase negative Staphylococci （MRCNS） was more than 80% ,ESBLs-producing E. coli 53.3 %, and ESBLs-producing Klebsiella pneumonia 35.4%. Antibacterial drug resistance was still a major problem. The changes of some antibacterial drug resistance stayed steady and there were even some drug resistance rates lower in 2012 than that in 2011. However, the resistance rate of proteus mirabilis in Enterobacteriaceae to imipenem was more than 75%, Acinetobacter baumannii and Pseudomonas aeruginosa to Hydrocarbon mildew alkenes on the rise year by year, Enteroeoccus faeeium to Vaneomycin up to 25%, candida albicans was to the five antifungal drug lower than 10% in average and Staphylococcus strains resistant to Vancomycin had not been found. Conclusion It is common that strains from non-sputum specimens are drug- resistant. There are downward trends in the resistance rates of main pathogens to some antibacterial drug, which requires the medical staff involved to enhance the monitoring, analyzing and managing of antibacterial drug use.