2012-2017年某综合教学医院临床分离病原菌的变迁及耐药趋势分析  

Analysis of distribution transition and drug-resistance trend of clinical pathogens isolated from a comprehensive teaching hospital from 2012 to 2017

作　　者：张然 刘智勇 吴柳 罗希 ZHANG Ran;LIU Zhi-yong;WU Liu;LUO Xi(Medical College of NanChang University,NanChang,Jiangxi 330031,China)

机构地区：[1]南昌大学医学院玛丽女王学院,江西南昌330031 [2]陆军军医大学第一附属医院检验科,重庆400038 [3]陆军军医大学第一附属医院医院感染管理科,重庆400038

出　　处：《中华医院感染学杂志》2018年第16期2463-2469,共7页Chinese Journal of Nosocomiology

基　　金：重庆市社会民生科技创新专项基金资助项目(cstc2015shmszx120110)

摘　　要：目的分析某医院六年间临床病原菌的分布、变迁及耐药性变化趋势,为抗菌药物合理使用和医院感染防控提供依据。方法于某综合教学医院2012年1月-2017年12月临床送检的各类标本中分离病原菌,采用全自动细菌鉴定及药敏分析仪进行病原菌的鉴定及药敏实验,观察比较不同年度病原菌的构成比、多药耐药菌检出率以及主要病原菌对临床常用抗菌药物的耐药率,所有数据采用WHONET和SPSS 19.0软件进行统计分析。结果临床微生物标本送检数量逐年上升,共379 869份,分离、鉴定出病原菌87 708株,其中革兰阴性菌58 504株占66.70%、革兰阳性菌18 931株占21.59%、真菌10 273株占11.71%,革兰阳性菌的构成比逐年小幅上升,真菌呈下降趋势(P<0.001);病原菌以肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、白假丝酵母为主,其中金黄色葡萄球菌的构成比逐年上升,白假丝酵母的构成比呈下降趋势(P<0.001);临床多药耐药菌检出率前三年呈上升趋势,2014年达到高峰后逐年下降(P<0.001);大部分革兰阴性菌仅对加酶抑制剂的β-内酰胺类、碳青霉烯类和氨基糖苷类抗菌药物的耐药率较低,但耐药性呈上升趋势,尤以鲍氏不动杆菌的耐药性更严重(P<0.05)。结论临床分离病原菌以革兰阴性菌为主,革兰阳性菌所致感染小幅上升,真菌感染呈快速下降趋势。革兰阴性菌对临床常用抗菌药物的耐药性严重,且呈增加趋势,临床应重视病原菌及耐药性监测,更加精准、合理使用抗菌药物,以有效减少耐药菌的产生和医院感染发生的风险。OBJECTIVE To analyze the distribution transition and drug-resistance trend of clinical pathogens isolated from a comprehensive teaching hospital from 2012 to 2017,so as to provide the basis for clinical rational antimicrobial therapy,as well as prevention and control of nosocomial infections.METHODS Pathogens were isolated and collected from all types of clinical samples from 2012 to 2017.Identification and antibiotic susceptibility tests of clinical pathogens were carried out by Vitek 2 Compact-32 automatic identification and drug-susceptibility analyzer.The constituent ratios of pathogens isolated from clinical samples,isolation rates of main multidrug-resistant pathogens and drug-resistant rates of main pathogens to antibiotics commonly used in clinical therapy were observed and compared.The statistical analysis of experimental data was performed by WHONET and SPSS19.0.RESULTS From 2012 to 2017,a total of 87708 strains of clinical pathogens were isolated from 379869 samples with the amount increasing every year.Among the isolated pathogens,66.70% were gram-negative bacteria,21.59% were gram-positive bacteria and 11.71% were fungi.The proportion of isolated gram-positive bacteria mildly increased year by year,but the proportion of isolated fungi declined sharply every year（P〈0.001）.The main species of pathogens with relatively high isolation rates were Klebsiella pneumoniae,Escherichia coli,Acinetobacter baumanii,Pseudomonas aeruginosa,Staphylococcus aureus,Candida albicans,accounting for13.5%,13.1%,12.5%,9.9%,8.6%,and 6.7%,respectively.The proportion of isolated S.aureus mildly increased year by year,but the proportion of isolated C.albicans declined sharply every year（P〈0.001）.The isolated rate of the multidrug-resistant bacteria rose up to 17.8% during 2012 to 2014 and then declined year by year（P〈0.001）.Most of the gram-negative bacteria,such as the Enterobacteriaceae bacteria and non-fermentative bacteria,were only susceptible to enzyme inhibitorsβ-lactams,carbapenems,aminoglycoside anti

关 键 词：病原菌 耐药性 抗菌药物 

分 类 号：R378[医药卫生—病原生物学]