【摘要】 目的了解医院2007-2011年临床分离的主要病原菌变化趋势,并对其耐药性进行监测分析,为临床更合理使用抗菌药物、减少耐药性的产生提供参考依据。方法对2007-2011年临床送检标本经VITEK-32全自动细菌鉴定及药敏分析仪对所分离的主要病原菌构成比以及耐药率分别进行统计。结果 2007-2011年主要病原菌检测总数总体呈上升趋势,前5位病原菌依次为大肠埃希菌(ECO)、金黄色葡萄球菌(SAU)、铜绿假单胞菌(PAE)、肺炎克雷伯菌(KPN)及鲍氏不动杆菌(ABA),2007年5种病原菌分离和构成比分别占26.5%、23.2%、12.6%、6.3%及5.9%;而在2011年则分别占15.2%、10.3%、23.4%、6.8%及15.4%;检出的ECO、SAU构成比呈逐年下降趋势,从2007年的26.5%、23.3%下降至2011年的15.2%、10.3%;而PAE的构成比逐年上升,从2007年的12.6%上升至2011年的23.4%,后两年构成比连续居于首位;KPN的构成比整体较稳定;而ABA构成比波幅较大,但整体呈上升趋势;ECO、PAE、KPN、ABA这4种革兰阴性菌均对青霉素类抗菌药物产生较高的耐药率,约100.0%,对头孢菌素类抗菌药物耐药率也逐渐上升;KPN对各类抗菌药物耐药率变化不大;PAE和ABA两种非发酵菌对亚胺培南耐药率在近5年中上升迅速;SAU对青霉素类和大环内酯类抗菌药物耐药率较高,对万古霉素未出现耐药菌。结论医院感染以革兰阴性菌为主,其中PAE和ABA构成比逐渐上升,青霉素类药物已经不适合于临床对革兰阴性菌和革兰阳性菌感染的治疗,亚胺培南可能在控制ECO和KPN的医院感染中发挥了重要作用,但不能有效控制PAE和ABA的传播,临床上需重视住院患者病原菌标本培养,加强抗菌药物合理使用,控制耐药菌株的出现。更多还原

【Abstract】 OBJECTIVE To analyze the change of distribution of the clinical pathogens isolated during 2007-2011 and to analyze the drug resistance so as to provide basis for the reasonable use of antibiotics and to reduce the emergence of drug resistance.METHODS The constituent ratio and drug resistance rates of the main clinical pathogens,which were isolated from the clinically submitted specimens during 2007-2011,were statistically analyzed by VITEK 32 identificntion and drug susceptibility analyzer.RESULTS The detection rates of the main pathogens showed a rising trend during 2007-2011.Escherichia coli(ECO),Staphylococcus aureus(SAU),Pseudomonas aeruginosa(PAE),Klebsiella pneumoniae(KPN) and Acinetobacter baumannii(ABA) were the top five species of pathogens,respectively accounting for 26.5%,23.2%,12.6%,6.3% and 5.9% in 2007,but accounting for 15.2%,10.3%,23.4%,6.8%,and 15.4% in 2011.The constituent ratios of ECO and SAU showed a declining trend during 2007-2011,while that of PAE showed an increasing trend and ranked the first place in the last 2 years.The constituent ratio of KPN remained stable,while that of ABA revealed significantly fluctuation,but showed a rising trend when viewed as a whole.Four species of gram-negative bacteria including ECO,PAE,KPN and ABA were highly resistant to penicillins,with the drug resistance rate around 100.0%,and the drug resistance rates to cephalosporins remained an upward tendency;KPN showed a stable resistance rate to all kinds of antibiotics.ECO and KPN showed slowly increasing resistance rate to imipenem in the last 5 years,while PAE and ABA showed rapidly rising resistance rate.SAU had a high resistance rate to penicillins and macrolides antibiot ics,but no strains of vancomycin-resistant SAU were found.CONCLUSION The gram-negative bacilli are dominant in the pathogens causing nosocomial infections,among which the constituent ratio of PAE and ABA keep an upward tendency.Penicillins are no longer suitable for the treatment of infections caused by gram-negative and gram-positive bacteria.Imipenem might play a significant role in the control of nosocomial infections caused by ECO and KPN,but can not prevent the spread of PAE and ABA effectively.It is necessary for the hospital to attach great importance to the specimens culture for the hospitalized patients and to reasonably use antibiotics so as to control the emergence of the drug resistant strains.更多还原