2006—2008年山东省立医院细菌耐药性监测分析 FREE

Bacterial resistance surveillance in Shandong Provincial Hospital between 2006—2008 FREE

摘要:

目的掌握某院病原菌分布及其耐药情况。方法收集该院2006年1月1日—2008年12月31日住院患者各类标本分离的非重复菌株资料，以WHONET 5.4软件进行数据分析。结果3年共分离病原菌5 697株，其中革兰阴性（G-）菌3 627株（63.67%），主要包括大肠埃希菌895株(15.71%)，铜绿假单胞菌873株(15.32%)，肺炎克雷伯菌446株(7.83%)，鲍曼不动杆菌366株(6.43%)；革兰阳性菌1 536株（26.96%），主要为金黄色葡萄球菌648株(11.37%)，肠球菌属373株(6.55%)，凝固酶阴性葡萄球菌349株(6.13%)。产超广谱β内酰胺酶细菌、耐甲氧西林金黄色葡萄球菌、耐甲氧西林凝固酶阴性葡萄球菌检出率逐年增高。病原菌标本来源前3位依次为痰（45.97%）、分泌物（16.54%）和尿（10.65%）。G-菌中的大肠埃希菌、肺炎克雷伯菌对碳青霉烯类药物耐药率为0.00%，但铜绿假单胞菌对其耐药率已达23.85%~31.76%；上述4种细菌对头孢哌酮/舒巴坦耐药率均＜15.52%，对其他抗菌药物耐药率均较高；大肠埃希菌对喹诺酮类药耐药率＞70%。未发现对万古霉素等糖肽类抗菌药物和利奈唑烷耐药的葡萄球菌，但该类病原菌对临床其他常用抗菌药物耐药率均较高，对克林霉素的耐药率多＞78.57%。结论该院住院患者病原菌主要分离自痰、分泌物和尿标本，以G-菌为主；细菌耐药性严重，开展细菌耐药性监测，对指导本单位合理应用抗菌药物具重要参考价值。

关键词:

细菌;病原菌;抗菌药物;抗药性，微生物;微生物敏感性试验;合理用药

Abstract:

ObjectiveTo get information about pathogenic distribution and bacterial resistance .MethodsData about bacteria isolated from inpatients who were hospitalized  between January 1st, 2006 to  December 31st, 2008 were collected and analysed with WHONET 5.4 software.Results5 697 pathogenic bacteria were isolated within 3 years,  which included 3 627 (63.67%) gramnegative and 1 536（26.96%）grampositive strains. Escherichia coli (895 strains,15.71%), Pseudomonas aeruginosa (873 strains, 15.32%), Klebsiella pneumoniae (446 strains,7.83%), Acinetobacter baumannii(366 strains, 6.43%) were the most common gramnegative isolates; Staphylococcus aureus(648 strains,11.37%), Enterococcus spp.(373 strains, 6.55%), and coagulasenegative Staphylococcus(349 strains,6.13%) were the top three grampositive isolates. The prevalence of extended spectrum βlactamases ( ESBLs) producing bacteria, methicillinresistant Staphylococcus aureus (MRSA) and methicillinresistant coagulasenegative Staphylococcus(MRCNS)  increased year by year. Bacteria were isolated from various specimens, the top three were  sputum (45.97%), secretion (16.54%) and urine (10.65%). Resistant rates of Escherichia coli, Klebsiella pneumoniae to carbapenems were all 0.00%, but 23.85%~31.76% of Pseudomonas aeruginosa isolates were carbapenemsresistant. Less than 15.52% of the above four kinds of bacteria were resistant to cefoperazone/ sulbactam, but they were highly resistant to other antimicrobial agents; more than 70% of Escherichia coli were quinoloneresistant. No Staphylococcus were detected to be resistant to glycopeptides, such as vancomycin and linezoid , but the resistant rates to the other commonly used  antimicrobial agents were relatively high, more than 78.57% Staphylococcus were clindamycinresistant. ConclusionPathogenic bacteria are mainly isolated from sputum, secretion and urine， the main pathogens are gramnegative bacteria； Antimicrobial resistance is very severe in hospitalized patients. Surveillance of antimicrobial resistance is important and valuable for rational antimicrobial therapy.

Key words:

bacteria; pathogen; antimicrobial agents; drug resistance , microbial; antimicrobial susceptibility test; rational use of drug