蛇口地区2008～2010年常见细菌分布及耐药性分析

目的 分析了解深圳蛇口地区2008～2010年3年间临床常见细菌分布及耐药性变化情况,为临床合理用药和有效控制感染提供依据.方法 对2008～2010年从临床分离的菌株进行鉴定以及测定其常用抗生素的药敏情况,再进行统计分析.结果 检出细菌以革兰阴性菌为主,占70.5％,革兰阳性菌占29.5％,检出率从高到低依次为大肠埃希菌28.6％；肺炎克雷伯菌12.8％；表皮葡萄球菌5.5％；金黄色葡萄球菌5.0％.药敏情况如下:3年间革兰阴性菌中大肠埃希菌和肺炎克雷伯菌产ESBLs菌株的检出率分别平均是26.0％和28.8％,3年间变化不明显(P＞0.05),大肠埃希菌对阿米卡星耐药率由7.6％上升到13.7％,对阿莫西林/克拉维酸耐药率由7.0％上升到16.1％,对头孢西丁耐药率由12.0％上升到21.7％,对头孢吡肟耐药率由16.6％上升到33.6％,对头孢唑啉耐药率由26.0％上升到41.9％,对哌拉西林/他唑巴坦耐药率由5.9％上升到19.9％,耐药率最高是氨苄西林和哌拉西林,耐药率在70％左右,其他抗生素如环丙沙星等这3年来变化不大(P＞0.05)；革兰阳性菌中耐甲氧西林细菌MRSE、MRSA明显上升(P＜0.01),分别由43.2％、29.0％上升到68.5％、44.6％.表皮葡萄球菌和金黄色葡萄球菌对阿莫西林/克拉维酸、复方新诺明、红霉素、四环素、头孢唑林耐药率均大于50％,对万古霉素敏感.结论 本地区3年来细菌检出率革兰阴性菌高于革兰阳性菌,革兰阴性菌中ESBLs菌株检出率近3年中呈平稳趋势,大肠埃希菌耐药率提高,并具有多重耐药特性；革兰阳性菌MRSE、MRSA明显上升,对多种抗生素耐药性升高,未检出万古霉素耐药株.

Bacteria distribution and drug resistance in Shekou area of Shenzhen City,2008-2010.

Objective To survey the antibiotic resistance of clinically isolated from Shekou,in Shenzhen City, 2008-2010. Methods The pathogens clinically isolated from Shekou hospital in 2008-2010 were determined and analyzed with MicroScan auto SCAN 4 microbial and NC31 ,PC20 bacterial identification and susceptibility plates. Results A total of 3 569 strains isolated from Shekou -ospit~ with Gram-negati,~e bacteria （70.5%） and Gram-positb~e bacteria （29.5%）. The top four pathogens were E. coli （28.6%）,K. pneumoniae （12.8%）,S. epidermidis （5.5%）S. aureus （5.0%）. In Gram-negative bacteria,the isolated rate of ESBLs-producing E. coli and K. pneumoniae in 2008-2010 were 26.0% and 28.8%, respectively, showing no significantly difference within three years （P〉0.05）. Resistance rate of E. coli was on the rise to the amikacin （from 7.6% to 13.7%）,to amoxicillin / clavulanic acid （from 7.0% to 16.1%）,to cefoxitin （from 12.0% to 21.7%）, to eefepime （from 16.6% to 33.6%）, to cefazolin （from 26.0% to 41.9%） , to piperaciUirdtazobactam （from 5.9% to 19.9% ）.The resistance to ampicillin and piperacillin possessed highest （about 70% ）,however,resistance to ciprofloxacin changed little within these three years （P〉0.05）. In Gram-positive bacteria,MRSE resistant to methicillin and MRSA increased significantly （P〈0.01） from 43.2%,29.0% to 68.5%,44.6%,respecitvely. Resistance rates of S.epidermidis and S. aureus to amoxicillin /clavutanic acid, cotrimoxazole, erythromycin,tetracycline,cefazolin was over 50%, and the two strains sensitive to vancomycin were found. Conclusion The bacterial detection rate of Gram-negative bacteria was higher than Gram-positive bacteria at Shekou area in 2008-2011. In gram-negative bacteria,the detection rate of ESBLs strains showed a smooth ~＇end during the past three years,resistance rate of E. coli has improved and showed multi-drug resistance; meanwhile,in gram-positive bacteria,MRSE,MRSA increased obviously,resistance to multiple antibiotics increased significantly, and vancomycin-resistant strains were not detected.