2014年至2016年某三级甲等医院多重耐药菌感染现状及耐药性分析

摘要

目的:对2014年至2016年某三级甲等医院多重耐药菌( MDRO)感染现状及耐药性进行分析.方法:采集2014年至2016年某三级甲等医院住院患者尿液、痰液、血液、分泌物等标本,分离其多重耐药菌株,并进行药敏试验.结果:53364 份送检标本中,MDRO 检出 2365 株,痰液 1002 株(42. 37%) ,尿液484株( 20. 47%) ,分泌物 295 株( 12. 47%) ,血液 250 株( 10. 57%) ; 2014 年 805 株( 34. 04%),2015年750株(31.71%),2016 年 810 株(34.25%);以 ECO 为主,1323 株(55.94%);MDRO 在ICU病房分布率最高,共检出453株(19.15%);金黄色葡萄球菌对青霉素、苯唑西林、氨苄西林的耐药率较高,对万古霉素、替考拉宁、利奈唑胺较敏感;大肠埃希菌对氨苄西林、环丙沙星、左氧氟沙星耐药率较高,对亚胺培南、阿米卡星、哌拉/他唑较敏感;肺炎克雷伯菌对环丙沙星、复方新诺明耐药率较高,对亚胺培南、哌拉/他唑较敏感;鲍曼不动杆菌对头孢曲松、环丙沙星、亚胺培南耐药率非常高;铜绿假单胞菌对头孢呋辛、头孢曲松耐药率较高,对氨苄西林较敏感.结论:该院 MDRO 检出率较高,临床应严格控制各科室抗菌药物的滥用,加强MDRO的监测.%Objective: To analyze the infection current status and drug resistance of multiple drug resist-ant organism ( MDRO) in a grade A tertiary hospital from 2014 to 2016. Methods: Samples of urine, sputum, blood and secretions were collected from hospitalized patients of a grade A tertiary hospital from 2014 to 2016, and their multi-drug resistant strains were isolated and the susceptibility test was given. Results: There were 2365 strains of MDRO, 1002 strains (42.37%) of sputum, 484 strains (20.47%) of urine, 295 strains (12. 47%) of secretions and 250 strains ( 10. 57%) of blood among 53364 examined samples. There were 805 strains (34.04%) in 2014, 750 strains (31.71%) in 2015 and 810 strains (34.25%) in 2016. And there were mainly ECO with 1323 strains (55.94%). The distribution rate of MDRO was the highest in ICU ward and 453 strains (19.15%) were detected. Staphylococcus aureus was highly resistant to penicillin, oxacillin and ampicillin and was sensitive to vancomycin, teicoplanin and linezolid. Escherichia coli was highly resistant to ampicillin, ciprofloxacin and levofloxacin and was sensitive to the imipenem, amikacin and piperacillin/tazobactam. Klebsiella pneumoniae was highly resistant to ciprofloxacin and cotrimoxazole and was sensitive to imipenem and piperacillin/tazobactam. Acinetobacter baumannii was highly resistant to the ceftriaxone, cipro-floxacin and imipenem. Pseudomonas aeruginosa was highly resistant to the cefuroxime and ceftriaxone and was more sensitive to ampicillin. Conclusions: The MDRO detection rate is higher in the hospital, and we should strictly control the clinical abuse of antimicrobial drugs in departments, and strengthen the monitoring of MDRO.