862例医院感染患者病原菌菌种及其耐药性分析  

Pathogen strains and drug resistance in 862 patients with nosocomial infection

作　　者：刘洁[1] 杨晶[1] 高立芳[1] 杨亚敏[1] LIU Jie;YANG Jing;GAO Lifang;YANG Yamin(Tianjin Third Central Hospital,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院

出　　处：《山东医药》2019年第27期33-37,共5页Shandong Medical Journal

基　　金：天津市应用基础与前沿技术研究计划(15JCQNJC11500)

摘　　要：目的分析862例医院感染患者病原菌菌种及耐药性.为控制医院感染提供科学的数据.方法选取我院862例医院感染患者,采集呼吸道、泌尿道、血液等标本,进行菌株培养检测,琼脂纸片扩散法检测菌株的耐药性.结果862例患者感染部位主要为上呼吸道感染58例份、下呼吸道感染304例份、菌血症121例份、腹盆腔内组织感染150例份、腹水感染36例份、泌尿道感染76例份.862例患者共分离出582株病原菌,其中革兰阴性菌400株,主要为肺炎克雷伯菌96株、大肠埃希氏菌105株、鲍曼不动杆菌75株;革兰阳性菌148株,主要为金黄色葡萄球菌35株、耐凝固酶阴性葡萄球菌58株;真菌32株,主要为白色念珠菌16株;支原体2株.革兰阴性菌对头孢呋辛、氨苄西林等耐药性较高,对亚胺培南、美罗培南、替加环素、多粘菌素B的耐药率较低.其中大肠埃希氏菌、肺炎克雷伯菌对头孢呋辛、氨苄西林、环丙沙星、米诺环素的耐药率高,耐药率均接近或>30%;铜绿假单胞菌对替卡西林、庆大霉素、米诺环素、呋喃妥因耐药率高,耐药率均>30%,鲍曼不动杆菌对多数临床常用抗生素广泛耐药,对米诺环素、头孢哌酮舒巴坦、替加环素、多粘菌素B耐药率低,革兰阳性菌对氨苄西林、红霉素、环丙沙星的耐药率较高,对万古霉素、替加环素、利奈唑胺、呋喃妥因、利福平耐药率较低.93株葡萄球菌属中甲氧西林敏感金黄色葡萄球菌(MSSA)11株、耐甲氧西林金黄色葡萄球菌(MRSA)24株、甲氧西林凝固酶阳性葡萄球菌(MSCNS)13株、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)45株.MSSA对青霉素、红霉素、四环素耐药率高,MSCNS对红霉素、庆大霉素抗生素耐药率>40%,对万古霉素、替加环素、利奈唑胺等较敏感.MRSA对红霉素、环丙沙星、四环素、克林霉素、复方新诺明的耐药率均>50%,对万古霉素、替加环素、利奈唑胺、呋喃妥因、利福Objective To analyze the pathogen strains and drug resistance of 862 patients with nosocomial infection,and to provide scientific data for the control of nosocomial infection.Methods Samples of respiratory tract,urinary tract and blood were collected from 862 patients with nosocomial infection in our hospital,and strain culture and AGAR paper diffusion were used to detect drug resistance.Results The infection sites of 862 patients mainly included 58 cases of upper respiratory tract infection,304 cases of lower respiratory tract infection,121 cases of bacteremia,150 cases of intrapelvic tissue infection,36 cases of ascites infection,and 76 cases of urinary tract infection.A total of 582 strains of pathogenic bacteria were isolated from 862 patients.Among the 582 pathogenic bacteria,there were 400 strains of gram-negative bacteria,including 96 strains of Klebsiella pneumoniae,105 strains of Escherichia coli and 75 strains of Acinetobacter baumannii;there were 148 gram-positive strains,including 35 strains of Staphylococcus aureus and 58 strains of Coagulasenegative staphylococci;there were 32 strains of fungi,mainly including 16 strains of Candida albicans,and 2 strains of Mycoplasma.Gram-negative bacteria had higher resistance to cefuroxime and ampicillin,and lower drug resistance rate to imipenem,meropenem,tegacycline and polymyxin B.The drug resistance rates of Escherichia coli and Klebsiella pneumoniae to cefuroxime,ampicillin,ciprofloxacin and minocycline were high,all of which were close to or>30%.The drug resistance rate of pseudomonas aeruginosa to ticacillin,gentamicin,minocycline and furantoin was high,with the drug resistance rate of>30%.Acinetobacter baumannii was extensively resistant to most commonly used clinical antibiotics,and had a low resistance rate to minocycline,cefoperazone sulbactam,tegacycline and polymyxin B.The resistance rate of Gram-positive bacteria to ampicillin,erythromycin and ciprofloxacin was higher than that of Gram-positive bacteria.There were 11 strains of methicillin-sensitive

关 键 词：医院感染 病原菌 肺炎克雷伯菌 大肠埃希氏菌 金黄色葡萄球菌 耐凝固酶阴性葡萄球菌 

分 类 号：R378[医药卫生—病原生物学]