2015—2017年广州中医药大学顺德医院病原菌的分布及耐药性分析

目的 了解广州中医药大学顺德医院病原菌的分布及耐药性，为临床治疗提供依据。方法 回顾性分析2015年1月-2017年12月广州中医药大学顺德医院的病原菌分布及耐药性。结果 共分离病原菌14 780株，其中革兰阴性菌8 426株，构成比为57.01%，主要为大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌；革兰阳性菌5 137株，占34.76%，主要为金黄色葡萄球菌、肺炎链球菌和凝固酶阴性葡萄球菌；真菌1 207株，占8.17%，主要为白假丝酵母。病原菌分离数量居前3位的科室分别为肿瘤内科、ICU和消化内科；标本主要来自痰液11 253株，占76.14%，来自伤口分泌物1763株，占11.93%，来自尿液1 524株，占10.31%；大肠埃希菌对阿米卡星、亚胺培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦及左氧氟沙星较敏感。鲍曼不动杆菌对被检抗菌药物的耐药性均处于较高水平，肺炎克雷伯菌对庆大霉素和左氧氟沙星较敏感，对其余抗菌药物的耐药性均在30%以上。铜绿假单胞菌对头孢西丁、头孢噻肟、复方新诺明及阿莫西林/棒酸具有超高耐药性；真菌对万古霉素有高敏感性，但普遍对红霉素、青霉素、克林霉素耐药严重。结论 应定期统计分析广州中医药大学顺德医院病原菌的耐药情况，为医生合理使用抗菌药物提供依据，同时应加强监管，降低细菌耐药性。

Analysis on distribution and drug resistance of pathogenic bacteria in Shunde Hospital of Guangzhou University of Chinese Medicine from 2015 to 2017

Objective To understand the distribution and drug resistance of pathogenic bacteria in Shunde Hospital of Guangzhou University of Chinese Medicine, and to provide basis for clinical treatment. Methods A retrospective survey was conducted to analyze the distribution and drug resistance of pathogenic bacteria in Shunde Hospital of Guangzhou University of Traditional Chinese Medicine from January 2015 to December 2017. Results Total 14 780 strains of pathogens were isolated, in which Gram-negative bacteria were 8 426 strains (57.01%), and main of them were Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Gram-positive bacteria (5 137 strains) accounted for 34.76%, and main of them were Staphylococcus aureus, Streptococcus pneumoniae and coagulase-negative Staphylococcus. Fungi were 1 207 strains (8.17%), and main of them were Candida albicans. The top three departments were Department of Oncology, ICU, and Gastroenterology. E. coli was sensitive to amikacin, imipenem, piperacillin/tazobactam, and levofloxacin. The resistant rate of A. baumannii against common antibiotics was high. K. pneumoniae was sensitive to gentamicin and levofloxacin, and the resistant rate against other antibiotics was above 30%. P. aeruginosa had the highest resistance against cefoxitin, cefotaxime, trimethoprim/sulfamethoxazole, and amoxicillin/clavulanic acid. Fungus was sensitive to vancomycin, and was resistant to erythromycin, penicillin, and clindamycin. Conclusion The statistical analysis of pathogenic bacteria in Shunde Hospital of Guangzhou University of Chinese Medicine should be conducted regularly to provide evidences for doctors to use antibacterial drugs reasonably. At the same time, regulation should be strengthened to reduce bacterial resistance.