2003～2008年医院细菌耐药性变化的分析  

Bacteria Drug Resistance Changes in Our Hospital from 2003 to 2008

作　　者：肖二辉[1] 石娜[1] 陈永平[1] 叶超[1] 卢明芹[1] 李骥[1] 

机构地区：[1]浙江省温州医学院附属第一医院感染科,浙江温州325000

出　　处：《中华医院感染学杂志》2010年第8期1146-1148,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析2003-2008年医院患者常见病原菌及其耐药情况,为临床合理应用抗菌药物提供支持。方法对医院2003年1月1日-2008年12月31日住院患者分离菌株及其对抗菌药物的耐药情况进行回顾性分析。结果2003-2008年医院共分离病原菌28 770株,其中革兰阴性杆菌19 967株,占69.4%,革兰阳性球菌8803株,占30.6%;所有分离病原菌中居前4位的为大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌和金黄色葡萄球菌;金黄色葡萄球菌和表皮葡萄球菌中耐甲氧西林菌株平均分别为71.1%和90.5%;革兰阳性球菌对万古霉素、替考拉宁的耐药性较低（〈5.0%）;葡萄球菌属和肠球菌属均发现少数耐万古霉素和替考拉宁株;大肠埃希菌和肺炎克雷伯菌中产ESBLs株平均分别为56.0%和35.9%,其对抗菌药物的耐药率（32.7%-56.0%）高于非产ESBLs株（23.1%-46.7%）;肠杆菌科细菌对碳青酶烯类的耐药性均很低（〈2.0%）,其次为头孢哌酮/舒巴坦和阿米卡星;非发酵革兰阴性杆菌逐年上升,且耐药率（35.0%-60.0%）普遍高于肠杆菌科细菌,以对头孢哌酮/舒巴坦的耐药率最低（〈35.0%）。结论医院细菌耐药呈增长趋势,加强对金黄色葡萄球菌和非发酵菌如鲍氏不动杆菌的耐药性检测,对于合理选用抗菌药物和控制细菌耐药性产生十分重要。OBJECTIVE To analyze the commonly distribution of pathogenic bacteria from 2003 to 2008 in our hospital and their drug resistance so as to provide strong evidence for clinically rational use of antibacterials.METHODS The isolated strains and their resistance from Jan 1st 2003 to Dec 31st 2008 to antibacterials were retrospectively analyzed.RESULTS A total of 28 770 bacterial isolates were collected from 2003 to 2008,which included 19 967（69.4%） strains of Gram-negative bacilli（GNB） and 8803（30.6%） of Gram-positive cocci（GPC）.Leading the first 4 places on the list of all the isolated strains was Escherichia coli,Pseudomonas aeruginosa,Acinetobacter baumannii,and Staphylococcus aureus.Meticillin-resistant S.aureus and S.epidermidis strains accounted for an average of 71.1% and 90.5%.GPC were both sensitive to vancomycin and teicoplanin.Several strains resistant to vancomycin and teicoplanin were found in both Staphylococcus spp and Enterococcus spp.ESBLs producing strains were detected in 56.0% and 35.9% of strains of E.coli and Klebsiella pneumoniae,respectively.The resistance rates of beta-lactamases producing strains in E.coli and K.pneumoniae（32.7-56.0%） were higher than those of non-producing strains（23.1-46.7%）.Strains of Enterobacteriaceae were still highly susceptible to imipenem and meropenem.The overall resistance rate to them was lower than 2.0%,and then to cefoperazone/sulbactam and amikacin.The incidence of non-fermentative Gram-negative organisms（35.0-60.0%） was higher,and their resistance rates were much higher than those of Enterobacteriaceae,the resistance rates（35.0%）to cefoperazone/sulbactam being the lowest among all the drugs tested.CONCLUSIONS Bacterial resistance is still increasing in our hospital,so it′s important to further enhance the surveillance of S.aureus and non-fermentative Gram-negative organisms,such as A.baumannii,in order to use antimicrobial agents rationally and control the bacterial resistance.

关 键 词：细菌耐药性 抗菌药物 分析 

分 类 号：R378[医药卫生—病原生物学]