张丽琴 刘婷 刘聪 邹淑慧 肖九长

摘   要：目的  了解贛南地区2013年～2016年临床分离的主要病原菌分布和多重耐药菌的流行变化。方法  采用梅里埃Vitek 2 compact对分离的菌株进行鉴定药敏。结果  4年内共分离41288株细菌，革兰阴性菌所占比例最高（67.00%）。病原菌分布中大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌位居前五。阿米卡星、哌拉西林/他唑巴坦对肠杆菌科细菌具有较高的的敏感性，鲍曼不动杆菌对多种常用抗菌药物呈现高水平耐药;铜绿假单胞菌对大部分抗菌药物较敏感，未检出万古霉素、利奈唑胺耐药的菌株。4年间耐甲氧西林金黄色葡萄球菌的检出均在25.00%以上;耐碳青霉烯肠杆菌科细菌的检出由2.90%上升至4.70%;耐碳青霉烯鲍曼不动杆菌的检出逐年下降。结论  赣南地区CRE的检出不断上升，临床应根据药敏合理选用抗菌药物，采取有效防控措施减缓多重耐药菌的产生。

关键词：临床病原菌;耐药性;多重耐药菌

中图分类号：R446.5                                  文献标识码：A                                DOI：10.3969/j.issn.1006-1959.2018.05.043

文章编号：1006-1959（2018）05-0123-02

Changes of Drug Resistance of Clinical Isolates and Epidemic Changes of Multidrug-resistant Bacteria in Southern Guizhou

ZHANG Li-qin，LIU Ting，LIU Cong，ZOU Shu-hui，XIAO Jiu-chang

（Department of Laboratory，Ganzhou People's Hospital，Ganzhou 341000，Jiangxi，China）

Abstract：Objective  To investigate the distribution of major pathogenic bacteria and the epidemic changes of multi-drug resistant bacteria in clinical isolates from 2013 to 2016 in south Jiangxi province.Methods  Meridier Vitek 2 compact was used to identify the drug sensitivity of the isolates. Results   In 4 years，41288 strains of bacteria were isolated，and Gram-negative bacteria accounted for the highest proportion（67.00%）.Escherichia coli，Acinetobacter bauman，Pseudomonas aeruginosa，Klebsiella pneumoniae，and Staphylococcus aureus were the top five in the distribution of pathogenic bacteria.The sensitivity of Amikacin and piperacillin/ tazobactam have higher of Enterobacteriaceae，Bauman acinetobacter to multiple antibiotics showed a high level of resistance; Pseudomonas aeruginosa to most sensitive antibacterial drugs， no detection of vancomycin and linezolid resistant strains.Over the past 4 years，the detection of methicillin-resistant Staphylococcus aureus was over 25.00%，and the detection of carbapenem Enterobacteriaceae increased from 2.90% to 4.70%.The detection of carbapenem resistant Acinetobacter bauman decreased year by year.Conclusion  The detection of CRE is increasing in Gannan area.The rational use of antibiotics should be selected according to drug sensitivity，and effective prevention and control measures should be taken to slow down the production of multi drug resistant bacteria.

Key words：Clinical pathogens;Drug resistance;Multi-drug resistant bacteria

2014年和2015年全国耐药监测网数据显示，江西省临床分离菌的耐药状况不容乐观。基于不同地区分离的菌株耐药性有所差异且不断变化，特别是多重耐药菌的出现与增加，使得了解细菌病原分布及对抗菌药物的耐药变迁成为必然。本文对2013年～2016年赣南地区三所三甲综合医院临床病原菌的耐药数据进行回顾性分析，现报告如下。

1 材料与方法

1.1菌株来源  2013年1月～2016年12月三所医院临床标本中分离的41288株病原菌，剔除同一患者重复菌株。……