2014年某三甲医院老年病人细菌耐药性监测

摘要:目的　了解2014年某三甲医院老年病人临床分离菌对常见抗菌药物的耐药性。方法　使用自动化细菌鉴定仪VITEK 2- COMPACT对分离菌株的耐药性进行鉴定，药敏结果按CLSI 2014年版标准判断。结果　临床分离的2167株细菌中，G-菌占69.4%，G+菌占30.6%。耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林的凝固酶阴性葡萄球菌（MRSCNS）的检出率分别为 29.5%、85.8%。葡萄球菌属中甲氧西林耐药株对所测试抗菌药物的耐药率显著高于甲氧西林敏感株，未发现对万古霉素和利奈唑胺耐药的菌株。对大部分所测抗菌药物，屎肠球菌的耐药率高于粪肠球菌。在屎肠球菌中发现9株万古霉素耐药株，在粪肠球菌中发现2株利奈唑胺耐药株。青霉素耐药的非脑膜炎肺炎链球菌占6.2%，非脑膜炎肺炎链球菌对红霉素耐药率为95.4%。检出53.8%的大肠埃希菌和28.2%的肺炎克雷伯菌产超广谱β-内酰胺酶。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为53.9%、52.9%，铜绿假单胞菌对上述两种药物的耐药率分别为33.9%、28.0%。结论　在大于65岁患者中分离的细菌耐药情况应引起足够重视，加强对医院感染控制和指导抗生素合理使用。

Bacterial resistance among elderly patients in a 3A hospital, 2014

Abstract: Objective To investigate the antimicrobial resistance of clinical isolates in our hospital among elderly patients during 2014. Methods Automated systems VITEK 2- COMPACT were used to test the bacterial susceptibility. Results were analyzed based on the 2014 CLSI. Results Of 2167 clinical isolates, gram-negative organisms and gram-positive organisms accounted for 69.4% and 30.6%. The prevalence of methicillin-resistant strain was 29.5% in S.aureus (MRSA) and 85.8% in coagulase-negative Staphylococcus (MRCNS). The resistance rates of MR strains to antimicrobial agents were much higher than those of MS strains. No staphylococcal strain was found resistant to vancomycin or linezolid. In Enterococcus spp, the resistance rates of E.faecium strains to most microbial agents tested were much higher than those of E.faecalis, 9 strains of E.faecium were found resistant to vancomycin, and 2 strains of E.faecalis were detected resistant to linezolid. Penicillin-resistant non-meningitis Streptococcus pneumonia accounted for 6.2%, and about 95.4% of Streptococcus pneumonia were resistant to erythromycin. The resistance rates of A.baumannii to imipenem and meropenem were 53.9% and 52.9% respectively, and the resistance rates of P. aeruginosa to imipenem and meropenem were 33.9%, 28.0%. Conclusion Drug resistance of bacterial isolated from aged over 65 years patients was still serious. It was very important to take effective measures to control hospital infections and improve rational antibiotic use.