某医院感染病区2011—2015年临床分离病原菌及其耐药性

目的了解湘雅医院感染病区患者临床分离病原菌分布及其耐药性。方法回顾性分析该院2011—2015年感染病区患者临床分离病原菌的构成及药敏结果。结果5年间共分离病原菌560株，其中革兰阳性菌247株（44.1%），革兰阴性菌313株（55.9%）。耐甲氧西林凝固酶阴性葡萄球菌和金黄色葡萄球菌分别占69.8%（81/116）和24.3%（9/37）。肠球菌对万古霉素、利奈唑胺、磷霉素有较高的敏感性（敏感率>81%）。肠杆菌科细菌对碳青霉烯类仍高度敏感（88.9%~100.0%），对阿米卡星、头孢哌酮/舒巴坦及哌拉西林/他唑巴坦的敏感性较高（敏感率>84%）。分离的多重耐药菌主要为鲍曼不动杆菌，耐亚胺培南鲍曼不动杆菌检出率从2011年的50.0%上升至2015年的77.8%，对亚胺培南的耐药率为64.9%。结论感染病区临床分离病原菌以革兰阴性菌为主，多重耐药菌检出率呈上升趋势；应根据病原菌的分布及其耐药性，合理选择抗菌药物。

Distribution and antimicrobial resistance of clinically isolated bacteria from department of infectious diseases of a hospital in 2011-2015

ObjectiveTo understand the distribution and antimicrobial resistance of pathogenic bacteria isolated from patients in the department of infectious diseases in Xiangya Hospital.MethodsThe distribution and antimicrobial susceptibility testing results of pathogenic bacteria isolated from patients in this department in 2011-2015 were analyzed retrospectively.ResultsA total of 560 strains were isolated during 5 years，of which gram positive bacteria and gram negative bacteria accounted for 44.1% (n=247) and 55.9%（n=313）respectively. 69.8%（81/116）of coagulase negative staphylococcus and 24.3%（9/37）of Staphylococcus aureus were methicillin resistant (MRCNS, MRSA) respectively. Enterococcus was highly susceptible to vancomycin, linezolid, and phosphonomycin (>81%). Enterobacteriaceae remained highly susceptible to carbapenems (88.9%-100.0%)，and was susceptible to amikacin，cefoperazone/sulbactam, and piperacillin/tazobactam (>84%). Acinetobacter baumannii was the major isolated multidrug resistant organism (MDRO), isolation rate of imipenem resistant Acinetobacter baumannii increased from 50.0% in 2011 to 77.8% in 2015, its resistance rate to imipenem was 64.9%.ConclusionThe majority of clinically isolated pathogenic bacteria from this department is gram negative bacilli，and detection rate of MDROs showed an upward trend; antimicrobial agents should be chosen according to distribution and antimicrobial resistance of pathogenic bacteria.