【摘要】 目的 探讨近5年来上海市胸科医院感染病原体的构成临床分布特点及耐药谱的动态变化，以指导临床合理应用抗生素。方法 应用MicroScan W/A-40K或BD Phornix-100系统鉴定细菌及药物敏感分析系统，对2000～2004年5年中送检的各类标本所分离的菌株进行鉴定及药敏测定。结果 5年中共收到各标本22755份，其中喉拭、痰液标本最多，占总标本数的89.2%。共检出阳性标本6634份，总菌珠培养检出阳性率为29.2%；内纤维支气管镜毛刷、痰液和各种分泌物阳性率最高。从各病区分布来看，其中每年均是以ICU和急诊科阳性检出率最高。5年中共分离出细菌5573株，内革兰阴性杆菌占61.3 %，革兰阳性球菌占38.7%。其中前五位的菌珠均为肺炎克雷白氏菌、铜绿假单胞菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌和白色念珠菌。真菌感染有明显上升的趋势，从2000年的第五位上升到2004年的第一位。对2002～2004年的细菌进行了药敏测定，结果表明，不论是革兰阴性杆菌还是阳性球菌，其耐药性均有不同程度地增加。亚胺培南和万古霉素对二种细菌的耐药率最低。结论 本院病人中分离的细菌耐药性强且多重耐药，应该了解各菌种的耐药特点和耐药机制，合理使用抗菌药物并严密监控新的耐药菌的产生。

    【关键词】 微生物；耐药性；感染

    The bacilli cultivation results and drug resistance features of patients from 2000 to 2004 in Shanghai chest hospital

    GU Yue-qing,LI Yan-wen,LI Zhi-fu, et al.

    Shanghai Jiaotong University, Shanghai Chest Hospital, Shanghai 200030, China

    【Abstract】 Objective To investigate the isolated strains and drug resistance spectra of inpatients in Shanghai chest hospital during the past 4 years, and to help doctors to use antibiotics rationally.Methods Use MicroScan W/A-40 or BD Phornix-100 system to identify bacilli and drug sensitive analysis system to determine the isolated strains from 2000 to 2004 in our hospital.Results In the five years, the whole strain detectable rates of all the 22755 samples were between 25.0% and 40.4%, positive rates of the fiberbronchoscope, sputum and various secretions were the highest, and the detectable rates were the highest in ICU and emergency department every year. The main microorganisms isolated from patients were Klebsiella spp, Pseudomonas aeruginosa, Staphylococcus coagulase-negative, Staphylococcus aureus, Candida albicans, and then Haemophilus, Enterobacter cloacae, Acinetobacter baumanni, S.maltophi and Escherichia coli. The detectable rate of fungus infection was ascending obviously from the fifth in 2000 to the first in 2004. The most common Gram-negative bacteria were Pseudomonas aeruginosa, Klebsiella spp and Enterobacter cloacae. The most common Gram-positive bacteria were Staphylococcus coagulase-negative and Staphylococcus aureus. The drug resistance rates of Gram-negative bacteria and Gram-positive bacteria were rising in 2002 and 2003. The drug resistance rates of imipenem and meropenem were the lowest.Conclusion The microorganisms isolated from patients in our hospital were highly and multi drug-resistant. It is very important to use antibiotics rationally to control the production of drug-resistant bacteria. ......