目的 分析我院2008～2011年临床分离的几种多重耐药细菌的分布和对抗菌药物的耐药性,为临床用药和控制感染提供依据.方法 共收集非重复的1812株临床分离细菌,采用Vitek-2 Compact全自动细菌鉴定/药敏分析仪对菌株进行鉴定及药敏试验,采用WHONE5.5软件进行药敏结果分析.结果 共分离2998株细菌,其中大肠埃希菌占21.11％ (633/2998),克雷伯菌占14.28％ (428/2998),肺炎链球菌占1.20％ (36/2998),葡萄球菌占23.85％ (715/2998).大肠埃希氏菌,克雷伯氏菌中产超广谱β内酰胺酶(extended-spectrum beta-lactamases,ESBLs)的检出率分别为58.93％(373/633),43.22％ (185/428),肠杆菌科中产ESBLs株对药物的敏感率比非产ESBLs株低,亚胺培南、哌拉西林/他唑巴坦、阿米卡星的敏感性仍较高.肺炎链球菌分离株中青霉素中介的肺炎链球菌(penicillin-intermediate streptococcus pneumoniae,PISP)和青霉素耐药的肺炎链球菌(penicillin-resistant streptococcus pneumoniae,PRSP)的检出率分别为16.67％、13.89％,对左氧氟沙星、万古霉素、利奈唑胺、莫西沙星仍保持较高的敏感性.葡萄球菌中的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)的检出比例平均为12.87％和50.21％,葡萄球菌中甲氧西林耐药株对β内酰胺类抗生素和其它测试药的耐药率显著高于甲氧西林敏感株,万古霉素、替考拉宁、替加环素和利奈唑胺仍是敏感性较高的药物.结论 细菌耐药性仍呈增长趋势,尤其是多重耐药菌的增多,对临床构成严重威胁,加强耐药性的监测,临床应结合药敏试验结果合理选择抗菌药物.%Objective To investigated distribution and antimicrobial resistance of multi-drug resistant bacteria of clinical isolates from our hospital, and provide the fact for clinical application of antibiotics and infection control. Methods A total of 1812 non-repetitive pathogenic bacteria of our hospital were collected in 2008 ～2011, Identification and antibiotic susceptibility tests were done by VITEK-2 system. The antibiotic susceptibility results were analyzed by WHONET 5. 5. Results Among the 2998 clinical isolates, Escherichia coli accounted for 21. 11% (633/2998), Klebsiella 14.28% (428/2998), Spneumoniae 1.20% (36/2998) , Staphylococcus 23.85% (715/2998). The prevalence of extended-spectrum β-lactamases ( ESBLs) was 58. 93% (373/633) in Escherichia coli, and 43. 22% (185/428) in Klebsiella, susceptibility test results show that the positive strains of ESBLs were much lower than the negative strains on drug sensitivity rate. Imipenem, Piperacillin/Tazobactam, Amikacin were high activity, The prevalence of peniciEin non-susceptible strains PISP and PRSP in the S. pneumoniae were 16. 67% and 13.89% respectively. All isolates were highly sensitive to Levofloxacin, Vancomycin, linezolid, and Moxifloxacin. Methicillin resistant strains in S. aureus(MRSA) and coagulase negative staphylococcus (MRCNS) accounted for an average of 12. 87% and 50. 21% respectively. The resistance rates of MR strains to βlaetams and other antimicrobial agents were much higher than those of MS strains. Vancomycin, Teicoplanin, Tigecycline and Linezolid are still highly active. Conclusion Bacterial resistance is on the rise, especially the incidence of multi-drug resistant bacteria, which has become a maior challenge to medical clinics. It was suggested that antibiotics should be chose to use according to antimicrobial susceptibility test results.
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