2012年3家教学医院无菌体液病原菌分布和耐药性  

Bacterial distribution and susceptibility from sterile body fluids in three teaching hospitals in 2012

作　　者：黄燕春[1] 陈知行[1] 谢轶[1] 刘宝[2] 费樱[2] 杜艳[3] 单斌[3] 康梅[1] 

机构地区：[1]四川大学华西医院实验医学科,成都610041 [2]贵阳医学院附属医院微生物免疫检验科,贵阳550004 [3]昆明医科大学第一附属医院医学检验科,昆明650032

出　　处：《中国抗生素杂志》2014年第6期456-461,共6页Chinese Journal of Antibiotics

基　　金：四川省科技厅科技支撑项目(2011SZ0125)

摘　　要：目的了解2012年中国西南地区三家教学医院临床分离自无菌体液病原菌的分布及耐药状况,为感染的预防与控制提供依据。方法运用WHONET5.5和SPSS16软件对3所西南地区三级甲等教学医院2012年无菌体液病原菌进行回顾性分析。结果脑脊液中共分离病原菌266株,包括革兰阳性菌161株、革兰阴性菌90株和真菌15株。分离最多的为凝固酶阴性葡萄球菌(CNS),其次为金黄色葡萄球菌和鲍曼不动杆菌。其他无菌体液标本(除脑脊液)中共分离病原菌720株,包括革兰阳性菌297株、革兰阴性菌411株和真菌12株。分离最多的为CNS、大肠埃希菌和克雷伯菌属。脑脊液标本中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为39.1%和75.9%。其他无菌体液标本中MRSA和MRCNS的检出率分别为45.8%和78.9%。分离自无菌体液的肠球菌出现了对万古霉素和利奈唑胺耐药的现象,其中屎肠球菌对万古霉素的耐药率高达11.5%。在肠杆菌科细菌中大肠埃希菌和肺炎克雷伯菌属细菌对亚胺培南的耐药率较低,而肠杆菌属细菌对亚胺培南的耐药率则较高(为23.5%)。非发酵菌对碳青霉烯类抗生素耐药率较高,其中鲍曼不动杆菌对亚胺培南的耐药率已大于60%。结论我国西南地区无菌体液病原菌构成与全国监测数据基本一致。无菌体液中MRSA检出率均低于全国监测水平,MRCNS检出率则较高。对万古霉素耐药的屎肠球菌分离率较高。非发酵菌特别是不动杆菌的耐药形势严峻。合理应用抗菌药物,加强医院感染控制应成为减少细菌耐药发生的重要策略。Objective To survey the distribution and susceptibility of the isolates from sterile body fluids in three teaching hospitals in Southwestern China in 2012 and provide a basis for prevention and control of infections. Methods Clinical data of pathogens isolated from sterile body fluids in 2012 was investigated retrospectively. Antimicrobial susceptibilities were analysed by WHONET 5.5 and SPSS16. Results A total of 266 organisms from cerebrospinal fluid were collected in the survey period which included 161 Gram-positive strains, 90 Gram-negative strains and 15 fungi strains. Coagulase-negative Staphylococcus （CNS）, Staphylococcus aureus and Acinetobacter baumannii were the most common isolates from cerebrospinal fluid. There were 720 organisms from sterile bodyfluid other than cerebrospinal fluid which included 297 Gram-positive strains, 411 Gram-negative strains and 12 fungi stains. CNS, Escherichia coli and Klebsiella spp. were the most common isolates from sterile body fluid other than cerebrospinal fluid. The percentage of methicillin-resistant Staphylococcus aureus（MRSA） and methicillin-resistant coagulase-negative Staphylococcus （MRCNS） from cerebrospinal fluid was 39.1% and 75.9%, respectively. The rates of MRSA and MRCNS from sterile body fluid other than cerebrospinal fluid were 45.8% and 78.9%. Enterococcal strains from sterile body fluids were found resistant to vancomycin and linezolid. The resistant rates of E. faecium to vancomycin were up to 11.5%. The prevalence of imipenem-resistant E. coli and Klebsiella spp. was not obvious, but the rate of Enterobacter spp. was high. Nonfermenters were highly resistant to carbapenems and the resistant rate ofAcinetobacter baumannii was especially high. Conclusion Bacterial distribution in the paper was basically consistent with the national surveillance data. The isolated rate of MRSA was lower than the resistant rate of MRSA in CHINET ,but the isolated rate of MRCNS was higher. The resistant rate ofE. faecium to vancomycin was high. The resistant

关 键 词：无菌体液 病原菌 耐药性 抗菌药物 

分 类 号：R378[医药卫生—病原生物学]