6289株院内感染病原菌的分布及耐药性研究

目的了解医院内感染的病原菌的分布及耐药状况。方法采用回顾性调查的方法，收集本院2003年至2007年问住院患者的标本，进行病原菌的分离、鉴定及药物敏感试验，同时监测耐甲氧西林葡萄球菌（MRS）及产超广谱β-内酰胺酶（ESBLa）的革兰阴性杆菌。结果所分离的6289株细菌中，G^-菌占71．7％（4510／6289），G^＋菌占21．3％（1338／6289），真菌占7．0％（411／6289）；常见的细菌是大肠埃希菌（24．3％）、铜绿假单胞菌（16．6％）、肺炎克雷伯菌（14．3％）、金黄色葡萄球菌（11．3％）及白色假丝酵母菌（6．2％）；细菌主要来自于ICU、神经外科、创伤科；耐药结果显示，G^-菌除对亚胺培南、头孢哌酮／舒巴坦及哌拉西林／他唑巴坦有较低的耐药率外，对常见的抗生素呈现较高的耐药率；金黄色葡萄球菌除对万古霉素及替考拉宁敏感外，对喹诺酮类、四环素类及克林霉素类等呈多重耐药。结论院内感染的病原菌主要以阴性杆菌为主，其次是阳性球菌，真菌感染也有上升的趋势。感染细菌不断增加的耐药性应该加强临床的抗菌药物使用的干预。

Pathogens distribution and drug rsistance study of 6289 strains in nosocomial infections

Objective To understand the clinical distribution and drug resistance characteristics of pathogens from nosocomial infection cases. Method Pathogens isolation, indentifieation and drug resistence tests were analyzed and collected by retrospective study from 2003 to 2007. Then MRS and ESBLs were detected. Result Among 6289 strains of pathogens, 71.7% were Gram-negative bacteria, 21.3% were Gram-positive bacteria and 7.0% were fungi. The main pathogens were Escherichia coli （24.3%）, Pseudomonas aeruginosa （16.6%）, Kelbsiella pneumonica （14.3%）, Staph- ylococcus aureus （11.3%） and Candida albicans （6.2%）. The clinical departments with higher infection rate were Department of ICU, Neurosurgery and Wound surgery. Drug resistance results showed that the resistance rates of Gram-negatives to imipenem, cefoperazone/sulbactam and piperacillin/tazobactam were lower, so were the resistance rates of S. au- reus to vancomycin and Teicoplain, while S. aureus had higher resistance to quinolones, tetracyclines and dindamycline. Conclusion The main pathogens from nosocomial infection were Gram-negative bacteria, followed by Gram-positive bacte- ria. The infection caused by fungi showed an increasing tendency as well. Due to the increasing drug resistance, rational use of antimicrobial agents should be stressed in clinical practice.