神经内外科革兰阳性球菌的分布及耐药性分析

摘要

目的 了解近6年笔者医院神经内外科院内感染革兰阳性球菌菌群分布及其耐药性,为临床合理应用抗菌药物提供实验室依据.方法 常规方法培养分离医院内感染病原菌,应用半自动或全自动细菌鉴定分析仪鉴定到种,药敏试验采用K-B纸片法,按CLSI规定的标准进行.采用WHONET5.6软件进行数据统计分析.结果 2006～2011年连续6年从笔者医院神经内外科临床感染的标本中共分离出革兰阳性球菌1276株,占全院革兰阳性球菌的21.06％(1276/6060),其中葡萄球菌1016株(79.62％)、肠球菌247株(19.36％)、链球菌13株(1.02％).葡萄球菌中,耐甲氧西林的金黄色葡萄球菌(MRSA)和表皮葡萄球菌(MRSE)的发生率均为88.9％,未发现对万古霉素、利奈唑胺及替考拉宁耐药的葡萄球菌.粪肠球菌和屎肠球菌对替考拉宁的耐药率分别为2.6％、0.7％,屎肠球菌对万古霉素的耐药率为2.6％,未发现对利奈唑胺耐药的肠球菌.结论 耐甲氧西林的金黄色葡萄球菌(MRSA)的分离率仍居高不下,是院内感染重要病原菌；临床应积极采取干预措施,有效的预防控制该菌引起的院内感染.%Objective To investigate the distribution and drug resistance against Gram-positive cocci from Neurology and Neurosurgery during six years,in order to provide laboratory data for clinical rational use of antibiotics.Methods Isolates were cultured by routine method and identified by the semi-automatic or automatic bacteria analysis system.The susceptibility testing was carried out according to a unified protocol of Kirby-Bauer method and results were analyzed according to CLSI standards.Data statistic and analysis used WHONET5.6 soft ware.Results Totally 1276 strains Gram-positive cocci were isolated in Neurology and Neurosurgery from 2006 to 2011,accounting for 21.06％ of the Gram-positive cocci isolated from the whole hospital,of which there were Staphylococcus of 1016 strains(79.62％),Enterococcus 247 strains (19.36％),Streptococcus 13 strains(1.02％).Both of methicillin resistant strains in Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) accounted for 88.9％.We didnt found resistance to vancomycin,linezolid and teicoplanin against staphylococcia.The drug resistant rates of E.faecalis and E.faecium against teicoplanin were 2.6％ and 0.7％.The drug resistant rates of E.faecium against vancomycin were 2.6％.We didnt found resistance to linezolid against Enterococcus.Conclusion MRSA which has high prevalence is one of the major pathogen in hospital infection.It is mandatory for hospitals to take effective control measures to prevent the spread of MRSA.