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目的探讨临床标本分离病原菌的分布及耐药性特征,为临床合理使用抗菌药物提供依据。方法对该院2013年临床送检的细菌检验标本1 936份进行细菌培养、鉴定和药敏试验,药敏试验结果判定依据临床和实验室标准协会(CLSI)颁布标准,采用实验室信息系统(LIS)进行数据分析。结果1 936份临床标本共检出病原菌461株,其中革兰阴性杆菌234株(50.76%),革兰阳性球菌123株(26.68%),真菌104株(22.56%)。常见病原菌为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、鲍曼不动杆菌。对于肠杆菌科细菌,亚胺培南美、洛培南和阿米卡星的抗菌活性最强;万古霉素和替考拉宁是葡萄球菌属敏感性最高的药物;对于非发酵菌,敏感的药物有亚胺培南和美洛培南等。大肠埃希菌和肺炎克雷伯菌中超广谱β-内酰胺酶的检出率为10.42%和5.00%,耐甲氧西林金黄色葡萄球菌为26.32%,耐甲氧西林凝固酶阴性葡萄球菌为70.00%。结论临床分离的细菌耐药状况比较严重,临床医生应重视病原菌的药物监测,了解细菌耐药性的变迁,合理选择和使用抗菌药物。
Objective To investigate the distribution and drug resistance characteristics of pathogenic bacteria isolated from clinical specimens and provide basis for the rational use of antibacterials in clinic. Methods The bacterial culture, identification and drug sensitivity test of 1 936 bacterial samples were performed in the hospital in 2013. The results of drug susceptibility testing were based on the standards promulgated by the Clinical and Laboratory Standards Institute (CLSI) and the laboratory information system LIS) for data analysis. Results A total of 461 pathogenic bacteria were detected in 1 936 clinical samples, of which 234 (50.76%) were Gram-negative bacilli, 123 (26.68%) were Gram-positive cocci and 104 (22.56%) were fungi. Common pathogens are Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Acinetobacter baumannii. For Enterobacteriaceae, imipenem, lopinam and amikacin have the highest antibacterial activity; vancomycin and teicoplanin are the most sensitive drugs for Staphylococcus; for non-fermentative bacteria, they are sensitive Drugs are imipenem and meropenem and so on. Escherichia coli and Klebsiella pneumoniae detection of extended-spectrum β-lactamase was 10.42% and 5.00%, methicillin-resistant Staphylococcus aureus was 26.32%, methicillin-resistant coagulase-negative staphylococcus Is 70.00%. Conclusion The clinical isolates of bacterial resistance are more serious. Clinicians should pay attention to the drug monitoring of pathogens, understand the changes of bacterial resistance, and select and use antibiotics reasonably.