2011年某三甲医院真菌和细菌耐药性分析

调查了2011年临床常见真菌、细菌、分离菌的耐药性．用VITEK32进行细菌鉴定和药敏实验，用纸片扩散法做药敏补充实验．临床共分离7961株菌，其中革兰氏阴性菌为50．76％，真菌为28．16％，革兰氏阳性菌为21．08％．分离的前6位菌依次为白色念珠菌、大肠埃希菌、金黄色葡萄球菌、鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌．酮康唑对真菌敏感率较高．金黄色葡萄球菌和凝固酶阴性葡萄球菌耐甲氧西林菌株率分别为76．1％、65．9％，未检测出耐万古霉素和利奈唑胺株．大肠埃希菌和克雷伯菌产ESBLs株分别为54．4％、37．2％，亚胺培南和美罗培南敏感率为100％．铜绿假单胞菌和不动杆菌属细菌表现多重耐药，铜绿假单胞菌对亚胺培南和美罗培南的耐药率为30％以上，不动杆菌属细菌对其的耐药率达75％以上，铜绿假单胞菌和不动杆菌属细菌对头孢哌酮／舒巴坦敏感率分别为73．2％和87．2％．结果表明，真菌感染增加，三代头孢耐药率增高，非发酵菌呈多重耐药并存在泛耐药株，应加强菌株耐药性监测，及时指导临床合理用药，以减少耐药菌株的传播．

Surveillance of Bacterial and Fungus Resistance from Third-grade Class-A Hospital in 2011

Our objective was to investigate the bacterial and fungus resistance of clinical isolates in 2011.VITEK 32 microbiological analyzer was used to identify the bacteria and test the drug sensitivity.The disc diffusion test was used to study supplementary antimicrobial resistance.Among 7 961 isolates,the gram negative organisms,fungus and the gram positive organisms accounted for 50.76%,28.16%,21.08%,respectively.The top six in sequence are Candida albicans,E.coli,S.aureus,Acinetobacter spp,Klebsiella spp,P.aerogenasa.The Fungal sensitivity ratio of Ketoconazole was high.The methicillin-resistant rates of S.aureus and coagulase negative Staphylococci were 76.1% and 65.9%,respectively.None of Staphylococci was found vancomycin and linezolid resistantance.54.4% of E.coli and 37.2% of Klebsiella spp produced ESBLs.None of E.coli and Klebsiella spp was resistant to imipenem and meropenem.The multiple durg resistance was shown in Acinetobacter spp and P.aerogenasa.Over 30% of imipenem and meropenem resistantance existed in P.aerogenasa and over 75% existed in Acinetobacter spp.Hence our conclusion:Fungus infection is increasing,the drug resistance rate of third generation cephalosporin is increasing in clinics.Multiple durg resistance and pan-drug resistance strains exist in non-fermentative bacteria.It is necessary to strengthen the surveillance of bacterial resistance to guide clinical rational drug using and reduce the spread of resistant strains in hospitals.