我院1995—1999年细菌流行分布及耐药监测

目的：了解我院住院及门诊患者细菌分布及耐药性发展趋势。方法：利用WHONET5软件分析1995－1999年自我院住及门诊患者分离细菌的种类、分布及纸片扩散法药敏试验数据。结果：绿脓假单胞菌、大肠埃希菌、凝固酶阴性葡萄球菌是我院住院及门诊患者的三大主要感染病原菌。它们对多数抗生素的耐药性呈逐年递增趋势，特别是大肠埃希菌对环丙沙星、派拉西林及复方新诺明的耐药性已分别达74．9％、81．1％及81．5％绿脓假单胞菌对头孢哌酮、环丙沙星、庆大霉素、阿米卡日程表主亚胺培南的耐药性分别从95年的23．7％、9．13％、21．1％、6．8％、6．3％增至99年的65％、31．3％、52．3％、23．4％及18．4％；个别细菌同时对多种抗生素具有多重高度耐药。特殊耐药细菌如耐甲氧西林金葡菌（MRSA）虽从95年的43．2％减少至99年的19．4％，但耐甲氧西林凝固酶阴性葡萄球菌却有所增加（从67．3％至74．2％）；产超广谱β内酰胺酶的大肠埃希菌和肺炎克雷伯菌99年的分离率分别为13％和16％；对高浓度庆大霉素耐药的粪肠球菌和尿肠球菌各占47．6％和61．1％。结论：临床应了解我院细菌对抗生素的耐药特点，掌握好适应证，科学合理选用抗生素，微生物实验室及临床科室应共同努力，尽量减少及延缓我院耐药细菌的发生及发展。

Bacterial distribution and the surveillance of its resistance to antimicrobial agents

Objective:To understand bacterial distribution and resistance trend of inpatints and outpatients in our hospital Methods:The kind distribution and antimicrobial susceptibility of bacteria isolated from 1995 to 1999 were analysed by WHONET5 software Results: Pseudomonas aeruginosa, Escherichia coli and coagulase negative Staphylococcus were the three major infectious pathogens in our hospital Their resistance to most antimicrobial agents increased obviously with the year Specially, resistance of E coli to ciprofloxacin, piperacillin and trimethoprim/selfamethoxazole was 74 7%, 81 1% and 81 5 respectively Resistance of P aeruginosa to cefoperazone, ciprofloxacin, gentamicin, amikacin and imipenem increased from 23 7%, 9 3%, 21 1%, 6 8% and 6 3% in 1995 to 65%, 31 3%, 52 3%, 23 4% and 18 4% in 1999 respectively Some bacteria possessed high and multiple antimicrobial agent resistance at one time MRSA reduced from 43 2% in 1995 to 19 4% in 1999, but oxacillin resistence coagulase negative Staphylococcus increased from 67 3% in 1995 to 74 2% in 1999 The isolated ratio of ESBL producing E coli and K pneumoniae was separately 13% and 16% in 1999 High level aminoglycoside resistant Enterococcus faecalis and Enterococcus faecium were 47 6% and 61 1% Conclusion: Resistance of the bacteria to antimicrobial agents was shown increasing trend in our hospital Clinical physician ought to understand the characteristics of bacterial resistance to antibitics in individual hospital, correctly and efficiently select antimicrobial agents Microbiology laboratory and clinical departments should have close cooperation to control the development of bacterial resistance