2011~2013年医院感染菌群分布及耐药状况分析  

Analysis of pathogenic bacterial distribution and drug resistance of hospital infection during 2011-2013

作　　者：朱俊民[1] 曹兴华[1] 

机构地区：[1]河南省漯河市中心医院检验科,河南漯河462000

出　　处：《国际检验医学杂志》2015年第7期925-926,929,共3页International Journal of Laboratory Medicine

摘　　要：目的统计医院患者细菌感染菌群的变化以及耐药情况,为医院内感染管理和临床合理用药提供参考依据。方法常规培养分离临床标本,采用梅里埃公司的VITEK2全自动微生物分析仪,对标本进行细菌鉴定和药敏分析。药敏确证实验,采用美国临床检验室标准化委员会（Clinical and Laboratory Standards Institute,CLSI）推荐的纸片扩散法,进行确证实验。结果2011~2013年医院感染的细菌标本来源以痰液、分泌物和中段尿为主;且感染的主要细菌呈上升趋势,排在前五位的细菌分别是：大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和金黄色葡萄球菌;常见的多重耐药菌,排前三位的是鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌,其在3年中的构成比有小幅度的增加;3年中革兰阴性杆菌（G-）耐药率大于70%的抗菌药物有：氨苄西林、头孢呋辛钠和头孢呋辛酯;革兰阳性球菌（G＋）耐药率大于70%的抗菌药物有：青霉素G和红霉素。除4例粪肠球菌外,没发现其他耐万古霉素的菌株。结论细菌感染的标本来源以痰液为主。革兰阴性杆菌是医院感染的主要致病菌,呈每年递增的趋势,多重耐药菌株也不断上升,青霉素类药物已不适用于临床细菌感染的治疗;亚胺培南对大肠埃希菌和肺炎克雷伯有很高的敏感性。医院应高度重视感染的管理,加强抗菌药物应用的监管,减少细菌感染的爆发和流行,减少耐药菌株的增加。Objective To statistically analyze the bacterial flora change and drug resistance situation in the patients with bacterial infection to provide reference for clinical rational drug use and the management of nosocomial infection.Methods The clinical samples were conventionally isolated and cultured.The bacteria identification and drug sensitivity test were performed by using the bioMerieux company VITEK2 automatic microorganism analyzer.The confirmation test of drug susceptibility adopted the disk diffusion method recommended by the American Clinical and Laboratory Standardization Committee（CLSI）.Results The sample sources in the hospital infection during 2011-2013 were main sputum,secretions and midstream urine;the main infectious bacteria showed the increasing trend,the top 5of bacteria were：Escherichia coli（ECO）,Klebsiella pneumoniae（KPN）,Acinetobacter baumanii（ABA）,Pseudomonas aeruginosa（PAE）,Staphylococcus aureus（SAU）;the top three of common multi-drug resistant bacteria were ABA,PAE and ECO,their constituent ratio during these three years had a small amplitude increase;the antibiotics for Gram negative bacilli（G-）resistance rate of more than 70% during these 3years were：ampicillin,cefuroxime sodium and cefuroxime axetil;the antibiotics for Gram positive cocci（G＋）resistance rate of more than 70% during these 3years were penicillin and erythromycin..Except for 4cases of Enterococcus faecalis,no other vancomycin-resistant strains were found.Conclusion The sample source of bacterial infection is dominated by sputum,the gram negative bacteria are the main force of hospital infection,showing a increasing trend every year,multi- drug resistant strains are also continuously rising,penicillin is unsuitable to the clinical treatment of bacterial infection;imipenem has very high sensitivity to ECO and KPN.The hospital should attach great importance to the infection management,strengthen the application and management of antibiotics,decrease the outbreak and prevalence of bacterial

关 键 词：医院感染 细菌 多重耐药性 抗菌药物 合理选用 

分 类 号：R197.323[医药卫生—卫生事业管理]