我院腹腔感染需氧及兼性厌氧病原菌及药物敏感性分析

摘要

目的研究我院2011年1月-2012年5月腹腔感染患者需氧及兼性厌氧病原菌分布及其体外抗菌药物敏感性.方法采用VITEK COMPACT全自动微生物鉴定及药敏分析仪进行菌种鉴定，药物敏感性检测采用微量稀释法，采用WHONET5.5进行结果分析.结果共分离病原菌111株，其中革兰阴性杆菌78株(70.3%)，革兰阳性菌33株(29.7%).分离率名列前7位的分别是大肠埃希氏菌、鲍曼不动杆菌复合群、屎肠球菌、肺炎克雷伯菌、铜绿假单胞菌、粪肠球菌和金黄色葡萄球菌.对肠杆菌科菌敏感性>90%的抗菌药物有亚胺培南(100%)，厄他培南(100%)，阿米卡星(97.7%)，哌拉西林/他唑巴坦(90.7%)，头孢替坦(90.7%)；鲍曼不动杆菌耐药率高，多重耐药株和泛耐药株的比例分别高达90%和60%；铜绿假单胞菌中多重耐药株检出率为14.3%；万古霉素、利奈唑胺和替加环素对所有屎肠球菌和粪肠球菌均敏感(敏感菌均为100%)；屎肠球菌整体较粪肠球菌耐药率高；未发现耐万古霉素金黄色葡萄球菌.结论我院腹腔感染的病原菌以革兰阴性菌特别是肠杆菌科菌为主，鲍曼不动杆菌是重要的院内腹腔感染菌且耐药率高，屎肠球菌是最常见腹腔感染革兰阳性致病菌.细菌耐药形势严峻，应采取积极有效的措施控制耐药菌的增多与传播.%Objective To investigate the distribution of aerobic and facultative anaerobe pathogens in patients with intra-abdominal infections in our hospital from January 2011 to May 2012 and their in vitro drug susceptibility. Methods Bacteria were identified using the VITEK COMPACT system. Their drug susceptibility was detected with microdilution method and analyzed with the WHONET5.5 software. Results Of the 111 isolated pathogens, 70.3%(78/111) were Gram-negative and 29.7%(33/111) were Gram-positive. The top 7 pathogens were Escherichia coli (21.6%), Acinetobacter baumannii 18.0%), Enterococcus faecium (16.2%), Klebsiella pneumoniae (6.3%), Pseudomonas aeruginosa(6.3%), Enterococcus faecalis (6.3%), and Staphylococcus aureus(4.5%). The susceptibility of Enterobacteriaceae to imipenem, ertapenem, amikacin, piperacillin-tazobactam and cefotetan 100%, 100%, 97.7%, 90.7% and 90.7%, respectively. The drug resistance rate of Acinetobacter baumannii was the highest. The proportion of multidrug resistant (MDR) strains and extensive drug resistant (XDR) strains of Acinetobacter baumannii was 90% and 60%, respectively. The multidrug resistant rate of Pseudomonas aeruginosa was 14.3%. All Enterococcus faecium and Enterococcus faecalis were susceptible to vancomycin, linezolid and tigecycline. The drug resistant rate of Enterococcus faecium is higher than that of Enterococcus faecalis. No vancomycin resistant Staphylococcus aureu were found. Conclusion Intra-abdominal infection pathogens in our hospital are Gram-negative bacilli especially Enterobacteriaceae. Acinetobacter baumannii are the important hospital acquired pathogen with a high drug resistance rate. Enterococcus faecium are the most common Gram-positive pathogen of intra-abdominal infections. The drug resistance of bacteria is still severe, more effective measures should be taken to control the prevalence of drug resistant strains.