1756株医院感染病原菌的菌群分布及耐药性分析

目的了解医院感染病原菌的菌群分布及其对常用抗菌药物的耐药情况,为临床合理使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。结果从临床分离出1 756株病原菌,主要来源于痰、分泌物及中段尿,三者之和占86.0%;分离的病原菌以肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌和白色假丝酵母菌为主,占感染菌株分离率的72.5%;病原菌分离率较高的科室为神经外科、呼吸科、监护室（ICU）、心胸外科;大肠埃希菌和肺炎克雷伯菌产ESBLs的阳性率分别为64.3%和61.7%,对头孢哌酮/舒巴坦和亚胺培南的耐药率在3.4%以下;非发酵菌对孢哌酮/舒巴坦的耐药率低于15.6%;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,产ESBLs状况十分严重。临床对产酶菌及非发酵菌引起的重症感染应首选头孢哌酮/舒巴坦和亚胺培南,对耐甲氧西林的葡萄球菌引起的重症感染应首选万古霉素来治疗。

Flora distribution and drug resistance analysis of 1756 strains of pathogenic bacteria of nosocomial infection

Objective To determine the distribution and drug resistance of bacteria flora in nosocomial infection,and provide laboratory evidence for selecting use of clinical antibiotics.Methods All isolates were identified by routine procedure.VITEK-compact 2 fully-automatic bacterial analyzer was used for identifying the bacteria and K-B paper disk were employed for drug sensitivity tests.Results There were 1756 strains isolated from clinical infectious specimen.Sputum,secretion and middle urine were the major specimen,which accounted for 86.0%.The major bacterial floras were K.pneumoniae,E.coli,S.aureus,P.aeruginosa,A.baumannii and C.albicans,with an isolation rate of 72.5%.The clinical departments with higher infectious rates were Department of Neurosurgery,Department of Respiratory Diseases,Intensive Care Unit（ICU） and Department of Cardio-thoracic Surgery.ESBLs-producing rates of E.coli and K.pneumoniae were 64.3% and 61.7% respectively.The drug resistance rates of the enterobacteriaceae to cefoperazone/sulbactam and imipenem were less than 3.4%.Non-ferment gram negative bacillus to cefoperazone/sulbactam was less than 15.6%.No drug-resistant enterococcus to vancomycin was found. Conclusion The clinical specimens are mainly from the respiratory tract and genitourinary tract.Now,the important bacterial floras are enterobacteriaceae in nosocomial infection.And the situation of ESBLs-producing strains in enterobacteriaceae is very severe.Cefoperazone/sulbactam and imipenem are the best choice to severe infections caused by ESBL-producing bacteria and the nonfermentive gram-negative bacillus.Vancomycin is the best choice to methicillin-resistant staphylococcus aureus and methicillin-resistant staphylococcus epidermidis.