肾内科住院患者感染的病原菌分布与耐药性分析

目的 分析2013年1月-2015年12月我院肾内科住院患者感染的主要病原菌及其耐药性，为临床合理应用抗生素提供依据。方法 采用Vitek 2 Compact全自动细菌鉴定及药敏分析系统进行病原菌的鉴定及药敏试验，根据美国临床实验室标准化协会（CLSI）2014年标准对药敏试验结果进行分析判断。结果 从肾内科住院患者中共检出560株病原菌，主要来源于尿（332株），其次为全血（141株）和痰液（40株）。560株病原菌以大肠埃希菌为主，共228株，占40.71%；其次为屎肠球菌和肺炎克雷伯菌，分别占9.11%和5.89%。不同病原菌对抗生素的耐药率也不同，大肠埃希菌对氨苄西林、哌拉西林及头孢唑林等的耐药率较高，分别为85.96%、81.32%和90.91%；屎肠球菌对克林霉素和莫西沙星的耐药率达100.00%，对氨苄西林、环丙沙星、青霉素G及环丙沙星的耐药率也很高，分别为98.00%、98.00%、97.73%和97.78%；肺炎克雷伯菌对氨苄西林和头孢唑林的耐药率较高，分别为94.74%和100.00%。结论 大肠埃希菌是肾内科住院患者感染的主要病原菌，大肠埃希菌及排名前几位的病原菌的耐药率都很高，临床应根据肾内科患者疾病特点及药敏试验结果合理应用抗生素。

Distribution and drug resistance of pathogens from inpatients with infectionsin nephrology department

Objective To investigate the distribution and drug resistance of pathogens from inpatients with infection in the nephrology department from January 2013 to December 2015．Methods Automatic bacteria identification and drug susceptibility analysis system（Vitek 2 Compact）was used for pathogen identification and susceptibility test；the results were analyzed according to the standards of CLSI 2014．Results A total of 560 strains of pathogens were isolated，which mainly came from urine（332 strains），blood（141 strains）and sputum（40 strains）．Among these strains，Escherichia coli was the predominant bacteria，accounting for 40.71%（228 strains），followed by Enterococcus faecium and Klebsiella pneumonia，accounting for 9.11% and 5.89% respectively．The resistance rates of Escherichia coli to ampicillin，piperacillin and cefazolin were 85.96%，81.32% and 90.91% respectively．The resistance rates of Enterococcus faecium to both clindamycin and moxifloxacin were 100.00%，and those to ampicillin，ciprofloxacin，penicillin G and ciprofloxacin were 98.00%，98.00%，97.73% and 97.78% respectively．The drug resistance rates of Klebsiella pneumonia to ampicillin and cefazolin were 94.74% and 100.00% respectively．Conclusion Escherichia coli is the main pathogen in hospitalized patients of nephrology department，which and other pathogens are highly resistant to antibacterial drugs．Appropriate and sensitive antibiotics should be empirically selected according to the characteristics of Department of Nephrology and the result of antibiotics susceptibility tests．