医院感染患者痰液中分离细菌的分布特征和耐药性变迁分析

目的了解2003—2005年医院感染患者痰液中分离细菌的分布特征和耐药性，为合理使用抗菌药物提供依据。方法大多数分离细菌的鉴定和药敏试验利用BD Phoenix仪，少数利用手工鉴定和K—B法药敏试验。数据分析用WHONET5．0软件。结果医院感染患者痰液中最常见的为铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌和表皮葡萄球菌。痰液中分离的G-杆菌合计，耐药率低于40％的为美洛培南、亚安培南、头孢哌酮／舒巴坦、哌拉西林-他唑巴坦、头孢他啶和头孢吡肟。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLa）的检出率为45．2％-62．5％和36．7％-52．3％。葡萄球菌对多肽类抗菌药物万古霉素的敏感率一直为100％，对其他抗菌药物的耐药率均大于30％。金黄色葡萄球菌和表皮葡萄球菌甲氧西林耐药性居高不下，分别为69．8％-72．0％、77．3％-87．1％。非发酵菌碳青霉烯类耐药率不断升高，铜绿假单胞菌对美洛培南和亚安培南耐药率已分别高达30．5％和49．4％。结论医院感染患者痰液中肠杆菌科产ESBLa比例、葡萄球菌甲氧西林耐药率和非发酵菌碳青霉烯类耐药率均较高，应加强抗菌药物的合理使用和采取有效的隔离措施以降低耐药率及多重耐药菌的扩散。

Resistance Analysis of Bacterial Isolates from Sputum of Nosocomial Infection Cases

Objective To investigate the distribution and drug resistance of bacterial isolates from sputum of nesocomial infection cases. Methods Most bacterial isolates were identified by BD Phoenix, a few were identified by handy-method and K-B method. WHONET 5.0 was applied for analysis. Results The common isolates were Pseudomonas aeruginosa, Klebsislla pneumoniae , Staphylococcus aureus , Staphylococcus epidermidis. In gram negative isolates, resistant rates of Meraopenem, Imipenem, Cefoperazone/Sulbactam, Piperacillin/Tasobactam, Ceftazidime, and Cefepime were under 40%. The incidences of E.coli and K. pneumoniae isolates producing extended spectrum betalactamase （ESBLs） were 45.2%-62.5% and 36.7%-52.3%, respectively. In staphylococci isolates, sensitive rate of vancomycin was 100%, resistant rates of others were over 30%. The methicillin resistant rates of S.aureus and S. epidermidis were 69.8%-72.0% and 77.3%-87.1%, respectively. Carbopenems resistance rates of non-ferment bacteria were increasing every year. Meraopenem and Imipenem resistant rates of P.aeruginosa were up to 30.5% and 49.4%, respectively. Conclusion The production ratios of ESBLs of ferment bacteria, methiciUin resistance of staphylococci, and carbopenems resistance of non-ferment bacteria from sputum were high. It is important to enforce the rational use of antimicrobial agents and take effective quarantine measures to reduce the resistant rates of bacteria and dissemination of multi-drug-resistant bacteria.