779家医院老年患者病原菌分布与耐药性分析..docx

779家医院老年患者病原菌分布与耐药性分析喻华 钟敏 黄湘宁 殷琳 刘鑫 张凯 黄文芳* （四川省医学科学院·四川省人民医院检验科，成都 610072）【摘要】目的 统计分析2012年我国65岁以上老年患者病原菌分布和细菌耐药特点。方法 全国557家三级医院和232家二级医院，按照监测方案要求，进行目标细菌收集、鉴定和药敏试验，负责单位依据CLSI2012年标准，用WHONET 5.6软件对收集到的监测资料进行分析和总结。结果 65岁老年患者共分离出295649株病原菌，排在前5位依次是大肠埃希菌18.6%、肺炎克雷伯菌14.6%、铜绿假单胞菌11.9%、鲍曼不动杆菌10.6%、金黄色葡萄球菌6.4%。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌ESBLs的产生率分别达到了61.8%、34.7%和28.5%；肠杆菌科对碳青霉烯类抗生素仍有较高的敏感性（敏感率>90%），此外对哌拉西林/他唑巴坦和头孢哌酮/舒巴坦也有较好的活性，耐药率均在12.0%以下。非发酵革兰阴性菌中铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为28.5%和48.5%，而多粘菌素B和头孢哌酮/舒巴坦有较好的抗菌作用。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）的检出率分别为51.2%和85.1%，未发现万古霉素和利奈唑胺耐药的葡萄球菌，仅凝固酶阴性葡萄球菌有对替考拉宁产生耐药（2.2%）。肠球菌对万古霉素、利奈唑胺和替考拉宁的耐药率均在3.8%以下。耐青霉素肺炎链球菌为4.9%。结论 65岁老年患者感染以革兰阴性菌为主，且多重耐药现象严重，急需加强细菌耐药监测，控制耐药菌的发展与传播。【关键词】细菌耐药监测；细菌感染；老年患者Distribution and analysis of drug resistance of pathogens of patients age more than 65 years in 779 hospitalsYu Hua, , Zhong Min，Huang Xiang-ning, Yin Lin ，Liu Xin，Zhang Kai, Huang Wen-fang*(Department of Clinical Laboratory, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu 610072)Abstract: Ojective To analyze the distribution and drug resistance characteristics of isolates from patients age more than 65 years in 2012 in China. Methods All the clinical strains were collected and the susceptibility tests were performed in the third class A level 557 hospitals and the second class A level 232 hospitals around China. The susceptibilities of isolates to antimicrobial agents were determined by using CLSI (2012) standards and the susceptibility data were processed with WHONET5.6 software by centre laboratory. Results A total of 295649 isolates were collected from patients age more than 65 years. The most predominant pathogens were Escherichia coli(18.6%), Klebsiella pneumonia(14.6%), Pseudomonas aeruginosa(11.9%), Acinetobacter baumannii(10.6%), Staphyloccous aureus(6.4%). ESBLs-producing rates of Escherichia coli, Klebsiella pneumonia and Proteus mirabilis were 61.8%、34.7% and 28.5%. A vast majority of Enterobacteriaceae