腹腔分离标本病原体构成及耐药性分析  

Bacterial distribution and resistance in abdominal specimens

作　　者：蔡鲜[1] 李妍淳[1] 李金[1] 田彬[1] 胡志东[1] 

机构地区：[1]天津医科大学总医院检验科,天津300052

出　　处：《中国抗生素杂志》2016年第10期782-787,共6页Chinese Journal of Antibiotics

基　　金：天津市应用基础与前沿技术研究计划项目(No.15JCYBJC26300)

摘　　要：目的监测我院2013—2015年腹腔分离标本病原体构成及耐药情况,为临床腹腔感染治疗提供参考依据。方法采用VITEK 2 Compact系统对病原菌进行鉴定,采用纸片法、MIC法和MTS法进行药敏试验,用WHONET5.6软件对结果进行分析。结果 3610份腹腔分离标本,培养获病原菌1408株,培养阳性率39.0%。剔除重复菌株后共983株病原菌,其中革兰阴性菌531株(54.0%),革兰阳性菌405株(41.2%),真菌46株(4.7%);居前5位的是大肠埃希菌、屎肠球菌、肺炎克雷伯菌、粪肠球菌、表皮葡萄球菌。金黄色葡萄球菌与凝固酶阴性葡萄球菌对甲氧西林耐药率分别为55.0%与76.1%,未发现对万古霉素、替考拉宁和利奈唑胺耐药的金黄色葡萄球菌。屎肠球菌的耐药率高于粪肠球菌,发现1株对万古霉素和利奈唑胺同时耐药屎肠球菌(VRE)。肠杆菌科细菌对碳青霉烯类、阿米卡星及加酶抑制剂复合制剂保持高度的敏感性,大肠埃希菌和肺炎克雷伯菌ESBLs检出率分别为56.3%和29.1%。铜绿假单胞菌和鲍曼不动杆菌对多重耐药检出率分别为9.6%和76.7%。结论我院腹腔标本分离病原菌以大肠埃希菌为代表的革兰阴性杆菌为主,肠球菌等革兰阳性菌所占比例有所增多。鲍曼不动杆菌检出率和耐药率呈上升趋势,应采取有效措施,控制耐药菌增长与传播。Objective To investigate the bacterial distribution and resistant to antibiotic of pathogens in abdominal specimens during 2013-2015 in our hospital and provide the basis for clinical treatment. Methods The isolated bacteria were identified by automatic VITEK-32 analyzer system and Disc diffusion test, MIC test and E-test were used to study the antimicrobial resistance. WHONET5.6 was applied for analysis the antibacterial sensitive data. Results A total of 1,408 pathogenic strains were isolated from 3610 intra-abdominal specimens, isolation rate was 39.0%. There were 983 non-repeated strains, isolation rate of Gram-negative bacteria, Gram-positive bacteria and fungi were 54.0%（n=531）, 41.2%（n=405） and 4.7%（n=46）. The top five pathogens were Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae, Enterococcus faecalis and Staphylococcus epidermidis. MRSA and MRCNS accounted for an average of 55.0% and 76.1%, respectively. No vancomycin, linezolid and teicoplanin resistant isolates were found in Staphylococcus. The antimicrobial resistance rate of Enterococcus faecium is higher than Enterococcus faecalis. One of E. faecium strain were resistant to vancomycin and linezolid. Enterobacteriaceae bacterias keep highly sensitivity for the carbapenems, amikacin and β-actamase with enzyme inhibitors. The detection rates of extened-spectrum β-lactamases （ESBLs） in E. coli and K. pneumonia were 56.3% and 29.1%, 76.7% of Acinetobacter baumannii and 9.6% Pseudomonas aeruginosa were mutidrug-residtant. Conelusion Gram-negative bacilli such as E. coli was predominant organism in intra-abdominal infections in our hospital. But Gram-positive bacteria such as Entercoccus increased obviously in recent years. The detection rate and resistance rate ofA. baumannii is on the rise, more effective measures should be taken to control the dissemination and growth of resistant strains.

关 键 词：腹腔感染 病原菌 耐药性 肠球菌 鲍曼不动杆菌 

分 类 号：R978.1[医药卫生—药品] R378[医药卫生—药学]