医院内感染病原菌的分布及耐药状况分析

摘要

目的：了解医院内感染病原菌的分布及耐药状况，为临床合理用药提供依据。方法常规培养分离鉴定，应用VITEKI和phoenix100全自动细菌鉴定分析仪系统鉴定菌株；药敏试验采用K-B纸片扩散法，根据CLSI规定的标准进行。结果2013年共检出6681株病原菌，临床分离的细菌主要以革兰阴性菌为主，大肠埃希菌、金黄色葡萄球菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌为分离菌株的前五位，分离率分别为17.2%、14.19%、13.31%、12.26%、9.52%，产ESBLs的大肠埃希菌和肺炎克雷伯菌分离率分别为56.94%、41.53%；耐甲氧西林金黄色葡萄球菌(MRSA)分离率为59.18%。检出耐万古霉素、耐利奈唑胺的金黄色葡萄球菌各1株。结论大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球仍是临床院内感染的重要病原菌，且对多种抗生素都处于比较高水平的耐药率，有逐年升高的趋势。临床微生物实验室应加强医院内重要感染病原菌的耐药性检测，临床应根据药敏结果和患者自身的感染状况制定出合理的个性化治疗方案，并高度重视多药耐药菌感染者的有效隔离，以防控耐药菌的扩散和流行。%Objective To investigate the distribution of pathogenic bacteria and drug resistance in our hospital in order to provide evidence for clinical rational drug use.Methods All isolates were identified by routine procedure and VITEK II and phoenix100 microbe automatic system, and drug susceptibility tests used K-B paper disk diffusion method in accordance with the CLSI standards.Results 6681strains of pathogenic bacteria were detected in 2013 year, clinical isolates of bacteria were mainly Gram-negative bacteria, Escherichia coli (E.Co), Klebsiella pneumonia(Kpn), Pseudomonas aeruginosa (Pae), Acinetobacter baumannii (Aba), Staphylococcus aureus (Sau) isolated from five for the year, the separation rate respectively is 17.2%、14.19%、13.31%、12.26%、9.52%, Escherichia coli and Klebsiella pneumoniae producing ESBLs throughout the year were 56.94%, 41.35%; methicillin-resistant Staphylococcus aureus (MRSA) isolates were 59.18%. The detection resistant to vancomycin, linezolid-resistant Staphylococcus aureus each one.Conclusion The E.coli、KPN、PAE、ABA and STA are main pathogens in nosocomial infection, and to antibiotics has been showed in a high level and there is an increasing trend of rate of drug resistantance. It is suggested to enhance the detection of multi-drug resistant bacteria. meanwhile clinic should be according to drug sensitive test results and patient self-infection situation to make rational optimization treatment,and taking effective isolation measures against multi drug resistant bacteria in order to prevent and control its proliferation.