2014年某综合性医院老年患者3 485株病原菌分布及耐药性分析

目的 了解2014年四川大学华西医院65岁以上老年患者感染病原菌分布情况及耐药特点。 方法 使用VITEK2-compact全自动微生物分析仪对分离菌株进行鉴定及药敏试验,结果按美国实验室标准化协会(CLSI)2014年标准判断。 结果 3 485株病原菌中革兰阴性菌2 916株(83.7%),革兰阳性菌464株(13.3%),真菌105株(3.0%)。分离前5位为鲍曼不动杆菌(18.8%)、大肠埃希菌(15.0%)、肺炎克雷伯菌(13.4%)、铜绿假单胞菌(13.3%)、嗜麦芽窄食单胞菌(6.9%)。大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶(ESBLs)的检出率为56.8%和27.7%。鲍曼不动杆菌和铜绿假单胞菌对阿米卡星的耐药率为4.0%~28.1%。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为34.3%、88.7%,未发现万古霉素耐药的葡萄球菌,仅凝固酶阴性葡萄球菌出现利奈唑胺耐药(2.0%)。除屎肠球菌对万古霉素耐药率为14.1%外,肠球菌对万古霉素、利奈唑胺的耐药率在2.2%以下。 结论 老年患者感染以革兰阴性菌为主,且耐药现象严重。加强细菌耐药监测,可指导临床治疗、有效预防及控制耐药菌株的产生和传播。

Distribution and drug resistance of 3 485 pathogens among the elderly patients in general hospital,2014

Objective To investigate the distribution and antibiotic resistance of clinically isolated pathogens among the elderly patients in West China Hospital during 2014. Methods Strains isolated from elderly patients were identified by automated systems VITEK 2- COMPACT,as well as the susceptibilities to antibiotic,which were determined by using the clinical and laboratory standards institute (2014). Results A total of 3485 clinical isolates were collected,among which 2916 (83.7%) were gram-negative bacteria,464 (13.3%) were gram-positive bacteria and 105 (3.0%) were fungus.The top 5 isolated pathogens were Acinetobacter baumannii (18.8%),Escherichia coli (15.0%),Klebsiella pneumonia (13.4%),Pseudomonas aeruginosa (13.3%),Stenotrophomonas maltophilia (6.9%),respectively.The extended-spectrum-β-lactamases producing rates of Escherichia coli and Klebsiella pneumonia were 56.8% and 27.7%,respectively.The resistance rate of Acinetobacter baumannii and Pseudomonas aeruginosa to amikacin was 4%~28.1%.The prevalence of methicillin resistance Staphylococcus aureus (MRSA) and methicillin resistance coagulase negative Staphylococcus (MRCNS) reached 34.3% and 88.7%,respectively.No vancomycin resistant Staphylococcus isolates were found. Coagulase negative Staphylococcus showed resistance to linezolid at 2%.Except the resistance rate of Enterococcus faecium to vancomycin (14.1%),the resistance rates of Enterococcus spp to vancomycin and linezolid were less than 2.2%.Conclusion The bacterial infection of elderly patients was mainly caused by a gram-negative bacterium and the phenomenon of drug resistance was serious.Enhancing the surveillance of resistance can direct clinical treatment,prevent the generation of drug-resistance bacteria and control their transmission.