摘要
目的了解近5年内医院感染菌群分布和流行趋势及耐药现状，为医院感染的控制和指导临床合理用药提供帮助。方法常规培养分离鉴定，应用VITEK全自动细菌鉴定分析仪和API鉴定系统鉴定菌株；药敏试验应用K-B纸片扩散法，按CLSI／NCCLS规定的标准进行。结果从2002-2006年共分离出11464株病原菌，感染标本主要为痰、分泌物及中段尿，3者之和占各年度的〉90．00％；感染菌以铜绿假单胞菌、大肠埃希菌、不动杆菌属、肠球菌属、葡萄球菌属和白色假丝酵母菌为主，分别占各年度分离率的57．02％、64．46％、57．83％、57．49％和60．73％；大肠埃希菌和肺炎克雷伯菌产ESBLs的阳性率为39．87％～61．98％，对头孢哌酮／舒巴坦和亚胺培南的耐药率分别〈14．06％和〈0．64％；非发酵菌对头孢哌酮／舒巴坦的耐药率〈33．22％；革兰阳性球菌对万古霉素的耐药率〈0．34％。结论非发酵菌已成为现在医院感染的重要病原菌群；铜绿假单胞菌、大肠埃希菌、鲍氏不动杆菌、粪肠球菌、白色假丝酵母菌和耐甲氧西林葡萄球菌（MRS）已成为医院感染的重要流行病原菌；肠杆菌科细菌产ESBLs状况十分严重，且有明显的上升趋势；对MRS引起的重症感染应首选糖肽类抗菌药物；对产酶菌及非发酵菌引起的重症感染，最好根据感染菌群耐药表型及药敏试验结果并密切结合患者的病情，联合应用抗菌药物治疗。
OBJECTIVE To understand the distribution or change and drug resistance of the bacteria flora in nosocomial infection, in order to provide laboratory evidence for controlling nosocomial infection and to indicate clinical antirnicrobial agents usage. METHODS All isolates were identified by routine procedure and VITEK microbe automatic system and API identified system. Drug susceptibility test was used K-B paper disk diffusion method in accordance with the CLSI/NCCLS standards. RESULTS There were 11 464 strains of bacteria which were obtained from 2002 to 2006. Sputum, secretion and middle urine were the major specimens. The major bacteria floras were. P seudomonas aeruginosa , Escherichia coli , Acinetobacter , Enterococcus , Staphylococcus and Candida albicans ,whose isolating rates were 57.02% in 2002,64.46% in 2003,57. 83% in 2004, 57.49% in 2005, and 60. 73% in 2006. E. coli and Klebsiella pneumoniae produced ESBLs rates were from 39. 87% to 61.98% that drug resistance rates to cefoperazone/sulbactam and imipenem were 14.06% and 0.64%. The drug resistance rates of nonferment Gram-negtive bacteria to cefoperazone/sulbactam were below 33.22%, Gram- positive cocci to vancomycin was below 0.34%. CONCLUSIONS Now, the important bacteria flora is nonferment Gram-negative bacteria in nosocomial infection. The P. aeruginosa,E, coli,Acinetobacter baumannii, Enterococ- cus faecalis, C. albicans, and meticillin-resistant staphylococcus （MRS） were prevalent important bacteria in nosocomial infection. The situation of producing ESBLs in Enterobacteriaceae is very severe. Glycopeptides are the best choice to MRS. To zymogenic bacteria and the nonferment Gram-negtive bacteria that cause severe infection, combining-drug treatment can be chosen according to drug susceptibility test results.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2009年第10期1276-1279,共4页
Chinese Journal of Nosocomiology
关键词
医院感染
菌群分布
抗菌药物
耐药性
Nosocomial infection
Bacteria flora distribution
Antimicrobial agents
Drug resistance
