2005--2007年临床分离细菌耐药性监测与分析

目的了解某医院临床分离常见病原菌的耐药情况，为合理应用抗菌药物提供依据。方法收集该院2005年1月1日--2007年12月31日间临床分离菌，采用VITEK系统进行菌种鉴定及常规生化试验，纸片琼脂扩散（K-B）法进行药敏试验。对所得数据用WHONET5．1软件进行统计分析。结果共收集病原菌4014株，其中革兰阳性菌1551株（38．64％），革兰阴性菌2463株（61．36％）。耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的构成比分别为49．82％和82．16％；未发现耐万古霉素革兰阳性球菌。大肠埃希菌、肺炎克雷伯菌超广谱β-内酰胺酶（ESBLs）的检出率分别为50．95％和47．53％。在葡萄糖非发酵菌中，铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为30．20％和27．06％；鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为19．62％和22．15％；嗜麦芽窄食单胞菌对复方磺胺甲嗯唑、左氧氟沙星较敏感，耐药率分别为6．85％和9．59％。结论定期进行耐药性监测有助于了解细菌耐药性变迁，为临床用药提供理论依据。

Surveillance and analysis on antimicrobial resistance of bacteria isolated from a hospital from 2005 to 2007

Objective To investigate antimicrobial resistance of clinical isolates obtained from a hospital and provide guidance for rational use of antimicrobial agents. Methods Clinical isolated bacterial strains were collected from a hospital from 2005 to 2007, baterial identification and routine biochemical tests were performed with VITEK system, antimicrobial susceptibility tests of isolates were carried out by Kirby-Bauer method. The data were analyzed with the software of WHONET 5. 1. Results A total of 4 014 pathogenic strains were collected, 1 551 （38. 64%） and 2 463 （61.36%） of which were gram-positive cocci and gram-negative bacilli respectively. The constitutional ratio of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase negative staphylococcus was 49. 82% and 82. 16% respectively; vancomycin-resistant gram-positive cocci were not found. The detection rate of extended-spectrum β-lactamases in Escherichia coli and Klebsiella pneumonia isolates was 50.95% and 47. 53% respectively. Among nonfermentative gram-negative bacilli, the resistant rates of Pseudornonas aeruginosa to imipenem and meropenem was 30. 20% and 27. 06% respectively, and 19. 62% and 22. 15% for Acinetobacter baumannii respectively. Stenotrophornonas maltophilia was sensitive to trimethoprim/sulfamethoxazole and levofloxacin, drug-resistant rate was 6. 85% and 9. 59% respectively. Conclusion Regular surveillance of antimicrobial resistance in clinical isolates is important for us to realize the trend of antimicrobial resistance and rational antimicrobial therapy.