目的 了解2011-2012年安徽省立儿童医院临床分离病原菌对常用抗菌药物的耐药性.方法 采用K-B纸片扩散法对该院临床分离的病原菌进行药敏试验.结果 共检出病原体3 946株,革兰阳性菌、革兰阴性菌、真菌、支原体各占43.92％、37.91％、15.91％、2.26％.居病原体首位的为大肠埃希菌(16.32％),其次为肺炎链球菌(16.02％)、金黄色葡萄球菌(9.00％)、肺炎克雷伯菌(7.40％)等.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)分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的41.41％(147/355)、81.40％(197/242);大肠埃希菌、肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)率分别为68.17％(439/644)、72.95％(213/292).肺炎链球菌对红霉素(99.84％)、克林霉素(98.58％)高度耐药;MRSA对克林霉素、红霉素的耐药率较高(＞75％),MRSA和MRCNS对万古霉素、替考拉宁和利奈唑胺敏感率均为100.00％;屎肠球菌对万古霉素耐药率为98.31％;鲍曼不动杆菌除对头孢哌酮/舒巴坦耐药率(8.70％)较低,对其他抗菌药物耐药率均较高;铜绿假单胞菌耐药率较低的抗菌药物有亚胺培南、美罗培南、头孢他啶、阿米卡星和环丙沙星(＜26％).检出4株对碳青霉烯类药物耐药的产ESBLs肺炎克雷伯菌,15株泛耐药鲍曼不动杆菌.结论 定期进行细菌耐药性监测,有助于了解医院细菌耐药变迁,为临床经验用药提供依据.%Objective To investigate the resistance of clinical bacterial isolates to commonly used antimicrobial agents in a hospital during 2011-2012.Methods Antimicrobial susceptibility testing of clinically isolated pathogens was performed by Kirby-Bauer method.Results A total of 3 946 pathogenic isolates were detected,gram-positive bacteria,gram-negative bacteria,fungi and mycoplasma accounted for 43.92％,37.91％,15.91％,and 2.26％ respectively.The top one isolate was Escherichia coli (16.32 ％),followed by Streptococcus pneumoniae (16.02 ％),Staphylococcus aureus (9.00％),and Klebsiella pneumoniae (7.40％) and so on.Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococcus (MRCNS) respectively accounted for 41.41％ (147/355) of Staphylococcus aureus and 81.40％ (197/242) of coagulase-negative staphylococcus; extended-spectrum β-lactamase-producing rate of Escherichia coli and Klebsiella pneumoniae was 68.17％ (439/644)and 72.95％(213/292)respectively.The resistant rate of Streptococcus pneumoniae to erythromycin and clindamycin was 99.84％ and 98.58％ respectively; the resistance rate of MRSA to clindamycin and erythromycin was higher (＞75 ％),the resistance rates of MRSA and MRCNS to vancomycin,teicoplanin and linezolid were all 100.00 ％ ;the resistance rate of Enterococcus faecium to vancomycin was 98.31％ ; the resistance rate of Acinetobacter baumannii to cefoperazone/sulbactam was low(8.70％),while to the other antimicrobial agents were all high; the resistance rate of Pseudomonas aeruginosa to imipenem,meropenem,ceftazidime,amikacin and ciprofloxacin were all low (＜26％).Four carbapenem-resistant ESBL-producing Klebsiella pneumoniae isolates and 15 pandrug-resistant Acinetobacter baumannii were detected.Conclusion Regular monitor on drug resistance of bacteria helps to understand the changes in bacterial resistance in hospitals,and provide the basis for empirical antimicrobial use.
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