2012 - 2014年海军总医院分离自无菌体液细菌的分布及耐药性分析

Analysis of bacteria distribution and drug resistance separated from sterile body fl uid in Navy General Hospital from 2012 to 2014

  • 摘要: 目的 了解2012-2014年我院从临床分离自脑脊液和其他无菌体液(胸腔积液、腹水、胆汁等)细菌的临床分布及耐药性,为临床合理选用抗菌药物提供依据。 方法 对我院2012 - 2014年脑脊液和其他无菌体液(胸腔积液、腹水、胆汁等)分离出的第一株细菌进行检出率、分布特点及药敏结果的回顾性分析。 结果 从2012 - 2014年分离无菌体液标本分别为120株、141株、160株。革兰阴性杆菌分离率> 70%;革兰阳性球菌分离率> 35%,革兰阳性真菌分离率> 8%。前列腺液、胆汁、脑脊液分离率逐年升高,均> 30%。前列腺液标本主要分离出阳性球菌,以表皮葡萄球菌为主;胆汁、胸腔积液主要分离出阴性杆菌,以大肠埃希菌为主。表皮葡萄球菌和溶血葡萄球菌对克林霉素、红霉素的耐药率均> 60%,青霉素耐药率均> 85%,3年未发现对呋喃妥因、奎奴普汀-达福普汀、替加环素、万古霉素、替考拉宁的耐药株。大肠埃希菌对喹诺酮类耐药性> 60%,但对哌拉西林/他唑巴坦、头孢替坦有很好的敏感性,对亚胺培南、阿米卡星、呋喃妥因、美罗培南无耐药性。肺炎克雷伯菌对美洛培南、呋喃妥因、头孢替坦、亚胺培南的敏感率则不如大肠埃希菌,均出现耐药现象。耐碳氢霉烯酶的肺炎克雷伯菌(CRE)3年耐药率逐渐升高,甚至超过15%。对铜绿假单胞菌敏感性较高的药物是阿米卡星,但氨苄西林/舒巴坦、头孢替坦、头孢曲松、头孢唑林、头孢呋辛钠、复方新诺明、呋喃妥因、头孢呋辛酯耐药严重,平均耐药率都在90%以上。 结论 无菌体液的主要病原菌耐药菌株有上升趋势,出现耐碳青霉烯酶的肺炎克雷伯菌,临床应根据耐药性监测数据进行合理的抗菌药物治疗,减少耐药菌株的产生。

     

    Abstract: Objective To study the clinical distribution and drug resistance isolated from cerebrospinal fluid and other sterile body fluid (pleural effusion, ascites, bile, etc.) in our hospital from 2012 to 2014, and provide guidance for clinicians in the rational use of antibiotic. Methods The isolation rate, distribution and drug resistance of the first isolated strains isolated from cerebrospinal fluid and other sterile body fluids (such as pleural effusion, ascites, bile) in our hospital from 2012 to 2014 were retrospectively analyzed. Results From 2012 to 2014, 120 strains, 141 strains, 160 strains of sterile body fluid specimens were separated, respectively. The most common specimen was gram-negative bacilli with separation rate of more than 70%, followed by gram-positive bacteria and fungi, with the separation rate of more than 35% and 8%, respectively. Prostate fluid, bile, cerebrospinal fluid's separation rate increased year by year, which were all more than 30%. From prostate fluid specimens, we mainly isolated positive coccus, in which epidermis staphylococcus was the most; From bile and chest water, we mainly isolated negative bacilli, in which E.coli was the most. The resistance rate of epidermis staphylococcus and hemolytic staphylococci to clindamycin and erythromycin were more than 60%; Penicillin's resistance rate was more than 85%; No strains were found to be resistant to Nitrofurantoin, Quinupristin/dalfopristin, Tigecycline, Vancomycin and Teicoplanin in 3 years. The resistance rate of E. coli to quinolone was more than 60%, with good sensitivity to Piperacillin/tazobactam, Cefotetan, while it had no resistance to Imipenem, Amikacin, Nitrofurantoin and Meropenem. The sensitivity of Klebsiella pneumoniae was less than E. coli to Meropenem, Nitrofurantoin, Cefotetan and Imipenem.The resistance rate of Klebsiella pneumoniae (CRE) in Hydrocarbon mildew resistant enzyme increased gradually in three years and reached even more than 15%. Pseudomonas aeruginosa was more sensitive to Amikacin; but it had severe drug-resistant to Ampicillin/sulbactam, Cefotetan, Ceftriaxone, Cefazolin, Cefuroxime sodium, SMZ-TMP, Nitrofurantoin and Cefuroxime Axetil, with the average drug resistance rate of more than 90%. Conclusion The resistant strains of pathogenic bacteria in sterile body fluids show a rising trend. Klebsiella pneumoniae is found to be resistant to carbon penicillium enzyme. It is important for clinicians to monitor the changes of pathogenic bacterial flora and their drug resistance tendency promptly, so as to decrease the production of drug-resistant strains.

     

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