郴州地区多重耐药菌感染的临床分析和耐药性监测  

Clinical analysis on multiple drug-resistant bacterial infection and drug-resistance monitoring in Chenzhou area

作　　者：吴志坚[1] 欧阳育琪[1] 吴龙祥[1] 程龙[1] 黄红卫[1] 

机构地区：[1]湖南省郴州市第一人民医院外科,423000

出　　处：《检验医学与临床》2012年第3期257-259,261,共4页Laboratory Medicine and Clinic

基　　金：郴州市第一人民医院资助科研项目(N2010-008)

摘　　要：目的通过多重耐药菌(MDRB)株的分离和耐药谱检测,为临床有效控制MDRB感染提供依据。方法按全国临床检验操作规程的要求分离细菌后,细菌鉴定和药敏试验均在惠州阳光公司半自动分析系统中进行,依据CLSI M100更新的标准判断药敏结果,根据标准筛选MDRB并计算耐药率。结果总共分离MDRB 13 957株,分离率56.97%。分离最MDRB依次是金黄色葡萄球菌、大肠埃希菌、凝固酶阴性葡萄球菌、鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌。金黄色葡萄球菌对氯霉素和利福霉素的耐药率小于32%,对四环素、庆大霉素、哌拉西林/他唑巴坦小于50.6%,对其余抗菌药大于51%。凝固酶阴性葡萄球菌对氟喹诺酮类、氯霉素、利福霉素耐药率小于40%。肺炎链球菌对氟喹诺酮类、氯霉素、利福霉素耐药率小于36%。近5年来耐甲氧西林金黄色葡萄球菌(MRSA)对四环素(2006～2009年)和哌拉西林/他唑巴坦(2006～2010年)的耐药率有逐年下降趋势,2007～2010年对氨苄西林、培氟沙星、左氧氟沙星耐药率有逐年上升趋势。磷霉素对嗜麦芽窄食单胞菌耐药率低,只有20%。阿米卡星对非发酵菌耐药率在32%～47%,对肠杆菌科细菌耐药率小于30%。对于阴性杆菌,头孢菌素耐药率在50%以上,喹诺酮类的耐药率在27%～81%。结论 MDRB对常用抗菌药物耐药严重,应高度重视病原学送检,根据药敏试验结果合理应用抗菌药物。Objective To isolate the multiple drug-resistant bacteria(MDRB) and to monitor the drug-resistance spectra to provide reference for controlling MDRB infection effectively.Methods Bacteria were purified according to the national clinical inspection SOP requirement.The bacterial identification and drug sensitivity test were performed in the semi-automatic analysis system produced by Huizhou Sunshine Company.The CLSI M100 update standard was adopted to judge the antimicrobial susceptibility test results.MDRB were screened according to the standard and the drug-resistance rate was calculated.Results 13 957 strains of MDRB were isolated with the isolation rate of 56.97%.The majority of MDRB were Staphylococcus aureus,Escherichia coli,Coagulase-negative staphylococcus,A.baumanii,Klebsiella pneumoniae,Pseudomonas aeruginosa.The resistance of Staphylococcus aureus to chloramphenicol and rifamycin was less than 32%,the resistance to minocycline,gentamicin,piperacillin/TAZ was less than 50.6% and to other antibiotics was more than 51%.The resistance of coagulase-negative staphylococcus to fluoroquinolones,chloromycetin and rifamycin was less than 40%.The resistance of Streptococcus pneumonia to fluoroquinolones,chloromycetin,rifamycin was less than 36%.Nearly five years,the resistance of MRSA to minocycline and piperacillin/TAZ was reduced year by year,but the resistance to ampicillin,pefloxacin and levofloxacin was increased year by year.Fosfomycin to Stenotrophomonas maltophilia showed low resistance,only 20%.The resistance of amikacin to non fermenters was 32%-47%,to Enterbacteriaceae was less than 30%.For negative bacilli,the resistance rate of cephalosporin was more than 50%.The resistance rate of fluoroqinolones was 27%-81%.Conclusion MDRB resistance to commonly used antimicrobials is serious.The etiologic detection should be paid high attention to.Antimicrobials should be rationally used according to the results of antimicrobial susceptibility test.

关 键 词：多重耐药菌 耐药性 微生物感染 

分 类 号：R512.6[医药卫生—内科学]