山东某院临床感染病原菌和常用抗菌药物敏感度分析  

Clinical infection of pathogens and antimicrobial sensibility analysis of some hospital in Shandong

作　　者：李平[1] 刘义刚[1] 金炎[1] 邵春红[1] 张淼[1] 范会[1] 郭凤琴[1] 

机构地区：[1]山东大学附属省立医院,山东济南250021

出　　处：《国际检验医学杂志》2015年第2期153-156,共4页International Journal of Laboratory Medicine

基　　金：山东省临床重点专科建设项目[鲁卫医字(2013)26号]

摘　　要：目的了解山东大学附属省立医院2012年临床送检标本中的主要病原菌及其对常用抗菌药物敏感度。方法采用法国生物梅里埃VITEK 2compact全自动细菌鉴定仪进行细菌鉴定,纸片扩散(K-B)法和抗菌药物最低抑菌浓度(MIC)法检测抗菌药物敏感度,共36中常用抗菌药物参与检测。结果住院患者分离病原菌3 269株(非重复),主要为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌和鲍曼不动杆菌,分别占25.54%、11.65%、11.62%、11.44%和8.23%。金黄色葡萄球菌380株,其中耐甲氧西林金黄色葡萄球菌(MRSA)31.82%、甲氧西林敏感凝固酶阴性葡萄球菌(MSSCNS)75.81%。大肠埃希菌835株,产超广谱β-内酰胺酶的大肠埃希菌(ESBL+ECO)62.99%、产超广谱β-内酰胺酶的肺炎克雷伯菌(ESBL+KPN)48.50%,肺炎链球菌和流感嗜血杆菌检出率明显增高。葡萄球菌对万古霉素(VA)、替考拉宁(TEC)、利奈唑烷(LZD)、呋喃妥因(F)、氯霉素(C)、米诺环素(MH)较敏感;肠球菌感染可选用VA、TEC、LZD和F治疗;铜绿假单胞菌对亚胺培南(IPM)、美罗培南(MEM)、头孢吡肟(FEP)、头孢他定(CAZ)、阿米卡星(AK)、氧哌嗪青霉素/他唑巴坦(TZP)、氧哌嗪青霉素(PIP)、头孢哌酮/舒巴坦(SCF)敏感率均在70.0%以上;鲍曼不动杆菌耐药性严重,除对IPM、MEM和替加环素(TGC)外,其他常用药物的耐药率均大于50.0%;嗜麦芽窄食单胞菌对复方磺胺甲噁唑(SXT)、MH和左氧氟沙星(LEV)敏感率均在89.0%以上。结论该院主要病原菌多为条件致病菌,对常用抗菌药物不同细菌敏感度不同,故应根据药敏结果,尽早将经验治疗转为病原治疗,合理应用抗菌药物,减少耐药菌株,提高临床治疗效果。Objective To investigate the bacterial distribution charateristics and antibiotic susceptibility during 2012 in Shandong Provincial Hospital Affiliated to Shandong University. Methods France bioMerieux VITEK2 compact automatic bacteria identifica- tion instrument were used in bacteria identification, Kirby-Bauer method and Minimum Inhibitory Concentration（MIC） method were used in the drug sensitive experiment. Results A total of 3 269 pathogenic bacteria strains were isolated, the top five pathogenic bacteria were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa and Aeinetobacter bauman- nii,accounting for 25.54%, 11.65% ,11.62% ,11.44% and 8.23% respectively. In 380 strains of Staphylococcus aureus,31. 820//00 was Methicillin-resistant Staphylococcus aureus（MRSA）,75.81% was Methicillin sensitive coagulase negative Staphylococcus au- reus（MRSCNS）. In 835 strains of Escherichia coli,62.99% was producing ultra broad spectrum beta lactamase of Escherichia coli （ESBL＋ECO）, 8.50 % was producing ultra broad spectrum beta lactamase klebsiella pneumoniae （ESBL＋ KPN）. The detection rate of Streptococcus pneunoniae and haemophilus influenzae increased significantly. Staphylococcus aureus, were sensitive to vanco- mycin （VA）, teicoplanin （TEC）, linezolid （LZD）, nitrofurantoin （F）, chloramphenicol （C） and M H （minocycline）. Enterococcus were sensitive to VA, TEC, LZD and F. More than 70.0 % of Pseudomonas aeruginosa were sensitive to imipenem （IPM） ,meropenem （MEM）, cefepime （FEP）, ceftazidime （CAZ）, Amikacin （AK）, piperacillin /tazobactam （TZP）, piperacillin （PIP）, cefopera- zone/sulbactam （SCF）. More than 50.0% of Acinetobacter baumannii were resistant to all the antibiotics tested except IPM,MEM and tigecycline （TGC）. More than 89.0 % of Stenotrophomonas maltophilia were sensitive to compound sulfamethoxazole （SXT）, MH and levofloxacin （LEV）. Conclusion Main pathogenic bacteria in this hospital

关 键 词：病原菌 多重耐药菌 抗菌药物敏感度 合理应用抗菌药物 

分 类 号：R446.5[医药卫生—诊断学]