某三甲医院6637株医院感染病原菌分布及耐药性分析

初瑞雪　刘信成　孟卫东

[摘要] 目的 探讨医院感染病原菌的分布及耐药情况，为临床合理用药提供依据。 方法 收集本院2016年1月～2017年9月分离的6637株病原菌，对标本来源、病原菌分布和耐药性进行分析。采用WHONET5.4软件对数据进行统计分析。 结果 病原菌分离阳性率高的标本是痰液（62.80%）；6637株病原菌中，革蘭阴性菌4230株，占63.73%；革兰阳性菌2166株，占32.64%；真菌241株，占3.63%；前5位病原菌依次为：大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎链球菌。革兰阴性菌对碳青霉烯类及哌拉西林/他唑巴坦敏感性较高（>80%），对其他药物表现出强耐药、多耐药、泛耐药；革兰阳性菌未发现耐万古霉素、利奈唑胺和替加环素的菌株；真菌对氟胞嘧啶敏感，对其他药物存在耐药，未发现高耐药菌株。 结论 该院呼吸道标本是病原菌分离的主要标本；革兰阴性菌为主要致病菌，大肠埃希菌是医院感染优势菌株；各病原菌存在不同程度耐药，甚至强耐药、多耐药、泛耐药，临床应重视细菌耐药检测，根据药敏试验结果合理用药，控制耐药菌发展，防止医院感染发生。

[关键词] 医院感染；病原菌；分布；耐药性

[中图分类号] R446.5 [文献标识码] B [文章编号] 1673-9701（2018）12-0116-04

Distribution and drug resistance analysis of 6637 strains of nosocomial infection in a three class A hospital

CHU Ruixue1 LIU Xincheng2 MENG Weidong1 ZHANG Shiying3 ZHANG Yunping4

1.Clinical Laboratory， Liaocheng Peoples Hospital in Shangdong Province， Liaocheng 252000， China； 2.Clinical Laboratory， Liaocheng Jiangbei Shuicheng Tourist Resort Lake West Street Office Community Health Service Center in Shangdong Province， Liaocheng 252000， China； 3.Institute for Communicable Disease Control and Prevention Center for Disease Control and Prevention of Liaocheng in Shangdong Province， Liaocheng 252000， China； 4.Department of Dermatology， Liaocheng People's Hospital in Shangdong Province， Liaocheng 252000， China

[Abstract] Objective To investigate the distribution and drug resistance characteristics of pathogenic bacteria in nosocomial infection cases so as to provide the basis for clinical rational drug use. Methods 6637 strains of pathogenic bacteria isolated from January 2016 to September 2017 were collected， and the source of the specimens， distribution of pathogenic bacteria and drug resistance were analyzed. WHONET5.4 software was used to analyze the data. Results The specimen with high positive rate of isolation of pathogenic bacteria was sputum（62.80%）. Among 6637 strains of pathogenic bacteria， there were 4230 strains of Gram-negative bacteria， accounting for 63.73%， 2166 strains of Gram-positive bacteria， accounting for 32.64%， and 241 strains of fungus， accounting for 3.63%. The top 5 pathogens were Escherichia coli， Staphylococcus aureus， Pseudomonas aeruginosa， Acinetobacter Bauman and Streptococcus pneumonia successively. Gram-negative bacteria were highly sensitive to carbapenems and piperacillin/tazobactam（>80%）， and showed strong resistance， multidrug resistance or pan resistance to other drugs. No strain of gram-positive cocci was found resistant to vancomycin， linezolid， and tetracycline. Fungi were sensitive to fluorine cytosine， and resistant to other drugs， and no high drug resistant strain was found. Conclusion The respiratory specimens in the hospital are the main specimens after the isolation of pathogenic bacteria. Gram-negative bacteria are the main pathogenic bacteria， and Escherichia coli is the dominant strain of nosocomial infection. The pathogenic bacteria are resistant to different degrees， and even show strong resistance， multidrug resistance or pan-drug resistance. Clinical attention should be paid to the detection of bacterial resistance， to the rational use of drug according to the results of drug sensitivity test， to the control of the development of drug-resistant bacteria and to the prevention of the occurrence of nosocomial infection.

[Key words] Nosocomial infection； Pathogenic bacteria； Distribution； Drug resistance

医院感染是患者、医护及陪护人员在医疗单位内因感染病原菌获得的感染性疾病，是临床医学面临的一个难题，日益受到重视的公共卫生问题[1]，大量抗菌药物的临床应用，造成病原菌的多药耐药，给医院感染的治疗方法和控制原则带来新的困难和挑战，越发受到医院的高度重视[2，3]。及……