2014年医院病原菌分布及耐药性分析

摘要

Objective To analyze the distribution and drug resistance rates of pathogenic bacteria causing nosocomial infections in our hospital in 2014 so as to provide guidance for reasonable clinical use of antibiotics.Methods The distribution of isolated pathogenic bacteria and the diug sensitivity results of patients from Beijing Luhe Hospital,Capital Medical University in 2014 were analyzed by WHONET 5.6.Results There were 2 863 strains of bacteria separated in 2014,including 50.3％ pathogenic bacteria from sputum specimens,18.8％ from the secretions samples,12.0％ from urine specimens;the pathogenic bacteria was mainly distributed in the severe medicine department(16.1％),followed by respiratory department(14.6％) and neurosurgery department(8.2％).The main pathogenic bacteria was gram negative bacteria,1 951(68.1％) were Gram-negative and 912(31.9％) were Gram-positive.The main Gramm-negative isolates were 360 Pseudomonas aeruginosa(12.6％),326 Acinetobacter baumannii (11.4％),326 Klebsiella pneumoniae (11.4％),263 Escherichia coli (9.1％).The main Gramm-positive isolates were 238 Staphylococcus aureus (8.3％),149 Staphylococcus epidermidis (5.2 ％),114 Hemolysis staphylococcus (4.0％) and 106 Enterococcus faecium (3.7 ％).The resistance rate of Acinetobacter baumannii to most common antimicrobial drugs was higher(＞ 65％),but 16.3％ to compound sulfamethoxazole;the drug resistance rates of P.aeruginosa to imipenem and meropenem were 20％.The drug resistance rate of methicillin-resistant Staphylococcus aureus was obviously higher than that of methicillin sensitive Staphylococcus aureus except quinupristin/dalfopristin,tetracycline,and no strains of Staphylococcus aureus resistant to vancomycin or linezolid were found.The drug resistance rate of Enterococcus faecium was obviously higher than that of Enterococcus faecalis except quinupristin/dalfopristin,tetracycline.Conclusion The Gram-negative bacteria are dominant among the isolated pathogens and are highly drug-resistant.It is necessary to reasonably use antibiotics on the basis of the distribution and drug resistance of the pathogens.%目的 了解我院2014年全年临床送检标本病原菌分布及其对常用抗菌药物耐药率,为临床合理选用抗菌药物提供参考依据.方法 选取2014年首都医科大学附属北京潞河医院全年由微生物实验室收集的各类检病原学标本,分析各类培养标本所分离的病原菌及药敏结果,并用WHONET 5.6软件进行统计.结果 2014年共分离病原菌2 863株,病原菌来源:痰标本占50.3％,分泌物标本占18.8％,尿液标本占12.0％;病原菌检出最多的科室为重症医学科,占16.1％,其次为呼吸内科,占14.6％,神经外科占8.2％;病原菌以革兰阴性菌为主,革兰阴性菌1 951株占68.1％,铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌分别占12.6％、11.4％、11.4％、9.1％.革兰阳性菌912株,占31.9％.金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌、屎肠球菌,分别占8.3％、5.2％、4.0％、3.7％;鲍曼不动杆菌除对复方磺胺甲(噁)唑耐药率(16.3％)较低外,对其他常用抗菌药物菌耐药率均＞65％,铜绿假单胞菌对亚胺培南、美罗培南的达20％;耐甲氧西林的金黄色葡萄球菌耐药率明显高于甲氧西林敏感的金黄色葡萄球菌(奎奴普定/达福普丁、四环素除外),未发现对万古霉素、利奈唑胺耐药的金黄色葡萄球菌,屎肠球菌对常见抗菌药物耐药率高于粪肠球菌(奎奴普定/达福普丁、四环素除外).结论病原菌以革兰阴性菌为主,耐药现象较为严重,应根据病原菌的分布及其耐药性合理选用抗菌药物.