陈旭 周文 王琳 李享宸 陈丽

[摘要] 目的 分析四川省涼山彝族自治州第一人民医院（以下简称“我院”）2015～2017年临床分离病原菌及其耐药性变迁。 方法 采用全自动微生物鉴定及药敏系统对我院2015年1月～2017年12月临床标本分离的病原性细菌进行鉴定及药敏试验，所有实验数据用WHONET 5.6软件进行分析。 结果 共分离出病原菌6529株，其中，革兰阴性菌占68.25%，革兰阳性菌占31.75%。革兰阴性菌以大肠埃希菌[1399株（21.43%）]、鲍曼不动杆菌[1017株（15.58%）]、肺炎克雷伯菌[518株（7.93%）]及铜绿假单胞菌[324株（4.96%）]最为常见。革兰阳性菌中前四位细菌分别为金黄色葡萄球菌[782株（11.98%）]、肺炎链球菌[261株（4.00%）]、表皮葡萄球菌[199株（3.05%）]和粪肠球菌[196株（3.00%）]。大肠埃希菌超广谱β-内酰胺酶（ESBL）菌株较往年检出率下降，但肺炎克雷伯ESBL菌株检出率稍有上升。鲍曼不动杆菌对多种抗生素耐药问题严重。未发现耐甲氧西林金黄色葡萄球菌，但2017年分离出20株（14.49%）万古霉素中介耐甲氧西林凝固酶阴性葡萄球菌。 结论 细菌耐药问题依然严重，合理使用抗菌药物、加强细菌耐药监测、隔离消毒等措施需进一步加强。

[关键词] 临床分离菌；耐药性；抗菌药物

[中图分类号] R446.5 [文献标识码] A [文章编号] 1673-7210（2018）05（b）-0163-06

Monitoring and analysis of clinical isolates′ drug resistance in the First People's Hospital of Liangshan Yi Autonomous Prefecture， Sichuan Province from 2015 to 2017

CHEN Xu ZHOU Wen WANG Lin LI Xiangchen CHEN Li

Department of Clinical laboratory， First Hospital of Liangshan Yi Autonomous Prefecture， Sicuan Province， Xichang 615000， China

[Abstract] Objective To investigate the clinical isolates and their changes in antimicrobial resistance in the First Hospital of Liangshan Yi Autonomous Prefecture of Sicuan Province （"our hospital" for short） from 2015 to 2017. Methods Automated bacterial identification and drug sensitivity system was used to explore the clinical specimens of microbial pathogens in our hospital from January 2015 to December 2017， and the drug susceptibility to conventional antibiotics was determined. The data was analyzed using WHONET 5.6 software. Results A total of 6529 non-duplicated clinical isolates was collected. Of the isolated germs， Gram-positive and Gram-negative bacteria accounted for 31.75% and 68.25%， respectively. The Gram-negative bacteria were mainly composed of Escherichia coli [1399 （21.43%）]， Acinetobacter baumannii haemolyticus [1017 （15.58%）]， Klebsiella pneumonia [518 （7.93%）] and Pseudomonas aeruginosa [324 （4.96%）]. The most common gram-positive bacteria were Staphylococcus aureus [782 （11.98%）]， Streptococcus pneumoniae [261 （4.00%）]， Staphylococcus epidermidis [199 （3.05%）] and Enterococcus faecium [196 （3.00%）]. The positive rate of extended-spectrum β-lactamase （ESBL） producing Escherichia coli was lower than before， but ESBL producing Klebsiella pneumoniae increased slightly. In addition， resistant multiple antibiotics of Acinetobacter Baumannii haemolyticus was severely. There were no methicillin resistant staphylococcus aureus， but 20 strains （14.49%） methicillin resistant coagulase negative staphylococci were isolated in 2017. Conclusion The problem of antimicrobial resistance is still serious. Measures， such as rational use of antibiotics， monitoring of drug resistance and medical asepsis， should be further strengthened.

[Key words] Clinical isolates； Antimicrobial resistance； Antibiotics

近年来，由于抗菌药物长时间联合使用，细菌耐药性逐年上升引起医院对细菌耐药性监测的重视[1-2]。了解四川省凉山彝族自治州第一人民医院（以下简称“我院”）常见的临床分离菌及耐药性变迁，对临床合理用药有一定的指导意义，也可以给本地区耐药监控提供参考。本研究将我院2015～2017三年的相关资料作统计分析，现报道如下：