普通外科病房病原体分布及其耐药性

目的调查某院普通外科病房病原体分布及其耐药性，为临床医生合理选择抗菌药物提供依据。方法对该院普通外科2011年1月-2012年12月临床送检各类标本分离的病原体种类、分布及耐药性进行回顾性分析。结果共分离病原体859株，其中革兰阴性（G-）菌563株(占65.54%)，革兰阳性（G+）菌233株(占27.12%)，真菌63株(占7.33%)；G-菌以大肠埃希菌(40.40%) 居多，G+菌以粪肠球菌(3.96%) 居多，真菌主要为白假丝酵母菌。病原体标本来源主要为腹腔引流/抽出液（65.43%，562株），其次为伤口或切口分泌物（10.94%，94株）、痰液（9.90%，85株）、胆汁（6.75%，58株）等。肠杆菌科细菌对亚胺培南、美罗培南不耐药，对阿米卡星、阿莫西林/克拉维酸、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦的耐药率均＜20%，对头孢菌素的耐药率较高。鲍曼不动杆菌对亚胺培南、美罗培南的耐药率高达51.85%、47.37%，对其他大部分抗菌药物的耐药率均＞60%，耐药率较低的是左氧氟沙星、阿米卡星，耐药率均＜20%。G+球菌对万古霉素的耐药率＜3.40%。结论该院普通外科住院患者医院感染主要病原体以G-菌为主，了解普通外科病房病原菌分布及加强细菌的耐药性监测，对临床医生合理选择抗菌药物，提高疗效，防止耐药菌株的产生及传播具有重要意义。

Distribution and drug resistance of pathogens isolated from a general surgery department

ObjectiveTo investigate the distribution and drug resistance of pathogens isolated from a general surgery department.MethodsThe category,distribution, and drug resistance of pathogens isolated from patients in a general surgery department from January 2011 to December 2012 were analyzed retrospectively.ResultsA total of 859 isolates of pathogens were isolated，563 （65.54%） of which were gram negative bacteria,233 （27.12%） were gram positive bacteria, and 63 （7.33%）were fungi. The most common gram negative bacteria was Escherichia coli （40.40%）， the dominant gram positive bacteria was Enterococcus faecalis （3.96%）, Candida albicans was the major fungus.Most pathogens were isolated from peritoneal fluid（65.43%，562 isolates）,followed by wound or incisional secretion（10.94%，94 isolates）,sputum （9.90%，85 isolates）, and bile（6.75%，58 isolates）. Enterobacteriaceae were not resistant to imipenem and meropenem,and resistant rates to amikacin, amoxicillin/clavulanic acid,piperacillin/tazobactam and cefoperazone/sulbactam were all 〈20%,the resistant rates to cephalosporins were high. The resistant rate of Acinetobacter baumannii to imipenem and meropenem was 51.85% and 47.37% respectively，and to most antimicrobial agents were 〉60%, but to levofloxacin and amikacin were both 〈20%. The resistant rate of gram positive bacteria to vancomycin was 〈3.40%.ConclusionThe major pathogens isolated from inpatients in this general surgery department are gram negative bacteria, survey on distribution and drug resistance of pathogens is important for the rational choice of antimicrobial agents, improvement of therapeutic efficacy,and prevention of the spread of drug resistant bacteria.