医院感染菌群分布趋势及耐药性分析

目的了解医院感染病原菌的菌群分布、流行趋势及其对常用抗菌药物的耐药情况,为临床合理应用抗菌药物提供依据。方法常规培养、分离细菌,应用VITEK-Compact 2全自动细菌分析仪鉴定细菌。常规药敏试验采用K-B纸片法。结果从2008—2010年共分离出5 138株病原菌,感染标本主要来源于痰、分泌物及中段尿,三者之和占年度的85%以上;分离的病原菌以肺炎克雷伯菌、大肠埃希菌、绿脓杆菌、金黄色葡萄球菌和白色假丝酵母菌为主,3年间分别占感染菌株分离率的73.6%、70.2%、62.8%;大肠埃希菌和肺炎克雷伯菌产ESBLs的阳性率均在60%以上,对头孢哌酮/舒巴坦和亚胺培南的耐药率均在10.8%以下;非发酵菌对孢哌酮/舒巴坦和亚胺培南的耐药率均在19.6%以下;未检出耐万古霉素的阳性球菌。结论医院内感染标本的来源主要以呼吸道和泌尿生殖道为主。肠杆菌科细菌已成为医院内感染的重要病原菌,肺炎克雷伯菌、大肠埃希菌、绿脓杆菌、金黄色葡萄球菌和白色假丝酵母菌为感染的流行菌。肠杆菌科细菌产ESBLs状况十分严重,临床对产酶菌引起的重症感染应首选头孢哌酮/舒巴坦或亚胺培南治疗。对非发酵菌引起的重症感染应选择含酶抑制剂复合药物(如哌拉西林/他唑巴坦、头孢派酮/舒巴坦)联合丁胺卡那进行治疗;对MRSA、MRSE引起的重症感染应首选万古霉素来治疗。

Analysis of distributing tendency and drug resistance of bacteria flora in nosocomial infection

Objective To determine the distributing tendency and the drug resistance of bacteria flora in nosocomial infection,and to provide laboratory evidence for clinical selecting antibiotics.Methods All isolates were identified by routine procedure and VITEK-Compact2 microbe automatic identified system,K-B paper disk was employed for drug sensitivity tests.Results There were 5138 strains isolated from clinical infectious specimen from 2008 to 2010.Sputum,secretion and middle urine were the major specimen whose rates were no less than 85% every year.The major bacteria flora were K.pneumoniae,E.coli,P.aeruginosa,S.aureus and C.albicans,whose isolated rates were 73.6% in 2008,70.2% in 2009,and 62.8% in 2010.E.coli and K.pneumoniae ESBLs-producing rates were more than 60%.The drug resistance rates of the enterobacteriaceae to cefoperazone/sulbactam and imipenem were less than 10.8%.Non-ferment gram negative bacillus to cefoperazone/sulbactam and imipenem were less than 19.6%.There was no drug-resistant enterococcus to vancomycin being found.Conclusion The clinical specimen are mainly from the respiratory tract and the urinary and procreative tract.The important bacteria floras are the enterobacteriaceae in nosocomial infection.The K.pneumoniae,E.coli,P.aeruginosa,S.aureus and C.albicans were prevalent bacteria in nosocomial infection.And the situation of ESBLs-producing strains in enterobacteriaceae are very serious.Cefoperazone/sulbactam or imipenem is the best choice to zymogenic strains,Enzyme-inhibitory drug(Piperacillin/Tazobactam or Cefoperazone/Sulbactam) with amikacin is the best choice to the non-ferment gram negative bacillus.Vancomycin is the best choice to MRSA and MRSE.