潍坊市某医院临床分离病原菌的分布与耐药分析

目的 分析临床分离病原菌的分布与耐药情况，为临床合理使用抗菌药物提供参考依据。方法 通过回顾性分析方法，对潍坊医学院附属医院2016年1月—2018年8月检验科分离出的病原菌进行统计，分析病原菌的临床分布及耐药情况。结果 对8941株非重复性细菌的进行综合分析，其中革兰阴性菌5176株(57.89%)，革兰阳性菌2587株(28.93%)，真菌1178株(13.18%)。革兰阴性菌以大肠埃希菌(20.88%)、肺炎克雷伯菌(10.09%)、铜绿假单胞菌(7.66%)为主，革兰阳性菌以金黄色葡萄球菌(7.52%)、表皮葡萄球菌(5.30%)为主，真菌主要是白假丝酵母菌(12.33%)。标本类型以痰液(27.50%)为主，其次是尿液及血液。儿科、胃肠肛门疾病外科、泌尿外科的病原菌检出率位于所有科室中的前3名。大肠埃希菌及肺炎克雷伯菌对氨苄西林/舒巴坦、头孢唑林、复方磺胺甲噁唑耐药率较高，对哌拉西林/三唑巴坦较为敏感。铜绿假单胞菌和鲍曼不动杆菌对头孢替坦、呋喃妥因耐药性较高，对阿米卡星较为敏感。金黄色葡萄球菌中，共检出195株MRSA，占29.02%。金黄色葡萄球菌及表皮葡萄球对青霉素G、红霉素耐药率较高，对万古霉素、替考拉宁和利奈唑烷较为敏感。结论 临床分离病原菌的耐药问题严重，医院应加强耐药菌的动态监测，根据耐药结果进行个体化用药，以减少耐药性的产生，提高治疗的准确性。

Analysis on distribution and drug resistance of clinically isolated pathogenic bacteria in a hospital of Weifang city

Objective The distribution and drug resistance of clinical isolated pathogens were analyzed to provide reference for rational use of antimicrobial agents. Methods By the method of retrospective analysis, the pathogenic bacteria isolated from the Laboratory Department of Weifang Medical college from January 2016 to August 2018 were analyzed and their clinical distribution and drug resistance were analyzed. Results The results of comprehensive analysis of 8,941 non-repetitive bacteria showed that 5,176 strains (57.89%) were Gram-negative bacteria, 2,587 strains (28.93%) were Gram-positive bacteria and 1,178 strains (13.18%) were fungi. Gram-negative bacteria mainly were Escherichia coli (20.88%), Klebsiella pneumoniae (10.09%), and Pseudomonas aeruginosa (7.66%). Gram-positive bacteria mainly were Staphylococcus aureus (7.52%) and Staphylococcus epidermidis (5.30%). The main fungi were Candida albicans (12.33%). The most sample types were sputum (27.50%), followed by urine and blood. In pediatrics, gastroenteroanal disease surgery, urology, the detection rate of pathogens was in the first three departments. Escherichia coli and Klebsiella pneumoniae had higher resistance to ampicillin-sulbactam, cefazolin and SMZ-TMP, but were sensitive to piperacillin-tazobactam. Pseudomonas aeruginosa and Acinetobacter baumannii had higher resistance to cefotetan and erythromycin, and they were sensitive to amikacin. Among Staphylococcus aureus, a total of 195 strains of MRSA accounted for 29.02%. Staphylococcus aureus and Staphylococcus epidermidis were more resistant to penicillin G and erythromycin, but sensitive to vancomycin, teicoplanin, and linezolid. Conclusion The problem of drug resistance of clinical isolated pathogens was serious. The hospital should strengthen the dynamic monitoring of drug resistant bacteria and carry out individualized drug use according to the results of drug resistance in order to reduce the occurrence of drug resistance and improve the accuracy of treatment.