目的 探讨医院感染革兰阴性杆菌的种类分布及耐药现状,为临床控制感染、合理使用抗生素提供科学依据。 方法 收集我院2011-01至2014-12临床住院患者送检标本,进行细菌鉴定和耐药性分析。结果 连续4年临床分离非重复革兰阴性杆菌共12 437株,肠杆菌科细菌6243株,占50.2%;非发酵菌5920株,占47.6%。主要检出菌中不动杆菌属2626株,占21.1%;铜绿假单胞菌2412株,占19.4%;肺炎克雷伯菌2093株,占16.8%;大肠埃希氏菌1049株,占8.5%。临床标本来源以呼吸道为主,其次为泌尿系统;脑外康复科以及ICU为感染高危科室。连续4年多重耐药细菌监测发现产ESBLs大肠埃希菌、肺炎克雷伯菌分别为(64.9%、64.3%、62.1%、55.4%)、(50.1%、47.7%、43.4%、45.7%)均呈现下降趋势。碳青霉烯类耐药大肠埃希杆菌、肺炎克雷伯菌分别为(0.8%、1.5%、1.3%、2.6%)、(17.4%、30.8%、27.1%、34.1%),呈逐年上升趋势。广泛耐药不动杆菌属4年平均检出率为40.3%。结论 临床分离病原菌以革兰阴性杆菌为主,多重耐药细菌上升趋势明显;医院应合理规范使用抗生素,减少耐药菌产生。同时,应加强细菌耐药监测,重视感染患者的隔离及护理,预防多重耐药菌导致的医院感染暴发流行。
Abstract
Objective To study the distribution and drug resistance of main gram-negative bacilli causing nosocomial infections in a certain hospital, so as to provide scientific basis for the infection control and reasonable use of antibiotics in clinics. Methods The main strains were collected from patients’ specimens in this hospital from 2011-2014 .The bacterial identification and drug susceptibility tests were performed and their drug resistance was retrospectively analyzed. Results A total of 12437 gram-negative isolates were collected from non- repetitive clinical specimens during the past four years,of which Enterobacteriaceae and non-fermentative Gram- negative bacilli accounted for 6243(50.2%) and 5920(47.6%), respectively. The Acinetobacter,Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli were the predominant species of Gram-negative bacilli,accounted for 21.1%,19.4%,16.8% and 8.5% respectively. The source of pathogenic bacteria specimens were mainly from respiratory tract and followed by urinary tract. Infection with high-risk departments were the brain injury rehabilitation department and ICU. By monitoring multi-drug resistant bacteria during four consecutive years,it was found that ESBLs-producing Escherichia coli and Klebsiella pneumoniae(64.9%,64.3%,62.1%,55.4%),(50.1%,47.7%,43.4%,45.7%) showed a trend of decline.But carbapenem- resistant Escherichia coli and Klebsiella pneumoniae(0.8%,1.5%,1.3%,2.6%),(17.4%,30.8%,27.1%,34.1%) had a rising trend year by year. During the past four years, the average detection rate of extensively drug-resistant Acinetobacter was 40.3%. Conclusions Most clinical isolates are Gram-negative bacilli and multi-drug resistant strains increase obviously.The reasonable clinical use of antibiotics is crucial for delay of emergence of drug-resistant strains. It is also necessary to strengthen the surveillance of drug resistance of the pathogens and prevent the spread of MDRO causing nosocomial infection.
关键词
细菌耐药监测 /
革兰阴性杆菌 /
多重耐药菌 /
药敏试验 /
碳青霉烯酶
Key words
bacterial resistance surveillance /
Gram-negative bacilli /
multi-drug resistant bacteria /
drug susceptibility testing /
carbapenemase
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