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目的分析2013年1月-2015年12月我院肾内科住院患者感染的主要病原菌及其耐药性,为临床合理应用抗生素提供依据。方法采用Vitek 2Compact全自动细菌鉴定及药敏分析系统进行病原菌的鉴定及药敏试验,根据美国临床实验室标准化协会(CLSI)2014年标准对药敏试验结果进行分析判断。结果从肾内科住院患者中共检出560株病原菌,主要来源于尿(332株),其次为全血(141株)和痰液(40株)。560株病原菌以大肠埃希菌为主,共228株,占40.71%;其次为屎肠球菌和肺炎克雷伯菌,分别占9.11%和5.89%。不同病原菌对抗生素的耐药率也不同,大肠埃希菌对氨苄西林、哌拉西林及头孢唑林等的耐药率较高,分别为85.96%、81.32%和90.91%;屎肠球菌对克林霉素和莫西沙星的耐药率达100.00%,对氨苄西林、环丙沙星、青霉素G及环丙沙星的耐药率也很高,分别为98.00%、98.00%、97.73%和97.78%;肺炎克雷伯菌对氨苄西林和头孢唑林的耐药率较高,分别为94.74%和100.00%。结论大肠埃希菌是肾内科住院患者感染的主要病原菌,大肠埃希菌及排名前几位的病原菌的耐药率都很高,临床应根据肾内科患者疾病特点及药敏试验结果合理应用抗生素。
Objective To analyze the main pathogens and drug resistance inpatients with nephrology inpatients from January 2013 to December 2015 in our hospital and provide the basis for rational use of antibiotics in clinic. Methods Vitek 2Compact automatic bacterial identification and drug susceptibility analysis system was used to identify the pathogen and drug sensitivity test. According to CLSI 2014 standard, the drug sensitivity test results were analyzed and judged. Results A total of 560 pathogenic bacteria were detected in inpatients of nephrology, mainly from urine (332), followed by whole blood (141) and sputum (40). The 560 strains of pathogens were mainly Escherichia coli with a total of 228 strains accounting for 40.71%, followed by Enterococcus faecium and Klebsiella pneumoniae, accounting for 9.11% and 5.89% respectively. The resistance rates of different pathogenic bacteria to antibiotics were also different. The resistance rates of Escherichia coli to ampicillin, piperacillin and cefazolin were high, which were 85.96%, 81.32% and 90.91% respectively. The rates of resistance to ampicillin, ciprofloxacin, penicillin G and ciprofloxacin were also high, with resistance rates of 98.00%, 98.00% and 97.73%, respectively 97.78%. Klebsiella pneumoniae showed high resistance rate to ampicillin and cefazolin, accounting for 94.74% and 100.00%, respectively. Conclusions Escherichia coli is the main pathogen in hospitalized nephrology inpatients. Escherichia coli and the top few pathogens of Escherichia coli are highly resistant. The clinical application of antibiotics should be based on the characteristics of the patients with renal diseases and the results of drug susceptibility test .