摘要目的 探讨2014年1月至2016年12月解放军沈阳军区总医院分离常见的临床病原菌的分布情况及抗菌药物的药性.方法 收集2014年1月至2016年12月解放军沈阳军区总医院临床分离的菌株18491株,剔除同一患者相同感染部位分离的重复菌株,相同标本类型的相同菌种只计入一次,采用MADLI-TOF-MS质谱仪(美国BD公司)及VITEK-2 Compact全自动细菌鉴定和药敏分析系统(法国梅里埃公司)进行细菌鉴定,个别抗菌药物采取纸片(英国 OXOIA 公司)扩散(K-B)法补充. 结果 按患者首次分离的菌株进行统计分析,排名前5位的细菌为肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、铜绿假单胞菌和金黄色葡萄球菌. 观察3年的送检标本类型,痰液标本占比下降到50%以下,无菌体液占比逐年增高. 3年来,肠杆菌科对碳青霉烯类药物的耐药性控制良好,但耐药率仍有所上升;鲍曼不动杆菌对阿米卡星耐药率下降,复方新诺明的耐药率升高;铜绿假单胞菌对阿米卡星、庆大霉素耐药率逐年下降;金黄色葡萄球菌对苯唑西林、环丙沙星等抗菌药物耐药率呈下降趋势. 结论 充分了解细菌分布的现状,有助于经验性用药的选择;优化送检标本的质量,选择合适的送检类型,提高检验结果的准确性、时效性;加强细菌的耐药性监测,有效及时地更改用药方案,加快临床治疗效果.

abstractsObjective To investigate the distribution and prevalence of antimicrobial susceptibility from January 2014 to December 2016.Methods A retrospective study was performed on 18 491 cases of isolates which were collected from January 2014 to December 2016.Weeded out the separation of the same pa-tients infected parts repeated strain,specimens of the same type of the same species included in one time,the MADLI-TOF-MS spectrometer and VITEK-2 Compact automatic bacteria identification and drug susceptibility analysis system(Meriere Company,France) to identify the bacteria,antibacterial drugs were taken individual pieces add diffusion method(K-B).Results Top five bacteria included Klebsiella pneumoniae,Acinetobact-er baumannii,escherichia coli,pseudomonas aeruginosa and staphylococcus aureus.After three years of obser-vation,sputum specimens accounted for less than 50%,the proportion of sterile body fluids increased year by year.Enterobacteriaceae had a good control over the resistance of carbapenems to drugs.The resistance rate of Acinetobacter baumannii to amikacin was reduced year by year,and the sulphame-thoxazole resistance rate was significantly increased.The resistance rate of pseudomonas aeruginosa to amikacin and gentamicin re-duced year by year.The resistance rates of staphylococcus aureus to oxacillin,ciprofloxacin and other antibiot-ics were reduced.Conclusion Fully understand the status of bacteria distribution,help the choice of empiri-cal medication;optimize the quality of the specimen,select the appropriate type of inspection,improve the ac-curacy and timeliness of the test results;strengthen bacterial resistance monitoring to make effective and time-ly changes in medication program for speeding up clinical treatment.