目的 探討2017-2019年江南大學(xué)附屬醫(yī)院臨床病原菌的分布及耐藥性，為臨床合理選用抗感染治療用藥提供參考依據(jù)。方法 采用法國(guó)生物梅里埃全自動(dòng)化藥敏儀器法或紙片擴(kuò)散法（K-B法）進(jìn)行抗菌藥物敏感性試驗(yàn)，并回顧性分析2017-2019年江南大學(xué)附屬醫(yī)院臨床病原菌的分布情況及耐藥性。結(jié)果 共分離出病原菌17 908株，其中革蘭陰性菌11 887株，占66.38%，主要為銅綠假單胞菌、肺炎克雷伯菌、大腸埃希菌和鮑曼不動(dòng)桿菌；革蘭陽(yáng)性菌5 402株，占30.17%，主要分布為金黃色葡萄球菌、腸球菌屬、凝固酶陰性葡球菌和鏈球菌屬；真菌619株，占3.46%，主要為白假絲酵母菌和熱帶假絲酵母菌。大腸埃希菌和肺炎克雷伯菌對(duì)替卡西林、頭孢唑啉、哌拉西林的耐藥率均達(dá)100%，且對(duì)其他藥物的耐藥率也是逐年上升；腸桿科病原菌對(duì)阿米卡星、阿莫西林/克拉維酸、替加環(huán)素、亞胺培南等藥物較敏感；非發(fā)酵菌中鮑曼不動(dòng)桿菌對(duì)頭孢他啶、頭孢替坦、以及氨芐西林/舒巴坦的耐藥率也是逐年上升趨勢(shì)。耐甲氧西林金黃色葡萄球菌（MRSA）的耐藥率為46.32%、耐甲氧西林凝固酶陰性葡萄球菌（MRCNS）的耐藥率為75.45%。耐甲氧西林金黃色葡萄球菌和凝固酶陰性葡萄球菌對(duì)大多數(shù)青霉素類以及復(fù)方新諾明等相關(guān)藥物的耐藥率呈上升趨勢(shì)，未發(fā)現(xiàn)對(duì)萬(wàn)古霉素耐藥的葡萄球菌。結(jié)論 2017-2019年江南大學(xué)附屬醫(yī)院臨床病原菌中肺炎克雷伯菌、鮑曼不動(dòng)桿菌以及大腸埃希菌的耐藥率呈逐年上升趨勢(shì)，而其他監(jiān)測(cè)細(xì)菌的耐藥率則比較穩(wěn)定。因而，微生物室和醫(yī)院感染科應(yīng)定期監(jiān)測(cè)各種病原菌耐藥性監(jiān)測(cè)，時(shí)刻關(guān)注耐藥性變遷，從而為醫(yī)院感染防治提供理論依據(jù)，并為臨床提供最適宜的抗生素治療方案。

Objective To explore the distribution and drug resistance of pathogens in the Affiliated Hospital of Jiangnan University from 2017 to 2019, so as to provide a reference for clinical rational selection of anti-infection drugs. Methods The antimicrobial susceptibility test was carried out by the French biomerie automatic drug sensitive instrument method or the paper diffusion method (K-B method), and the distribution and drug resistance of clinical pathogens in the Affiliated Hospital of Jiangnan University from 2017 to 2019 were analyzed retrospectively. Results Totally 17 908 strains of pathogenic bacteria were isolated, among which 11 887 strains were Gram-negative bacteria, accounting for 66.38%, and main of them were Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii. Gram-positive bacteria were 5 402 strains, accounting for 30.17%, and main of them were Staphylococcus aureus, Enterococcus, coagulase negative Staphylococcus, and Streptococcus. Fungi were 619 strains (5.21%), and main of them were Candida albicans and Candida tropicalis. The resistance rates of E. coli and K. pneumoniae against ticarcillin, cefazolin and piperacillin were 100%, and it was found that the resistance rate against other drugs was also increasing year by year. Enterostematic pathogens were sensitive to amikacin, amoxicillin/clavulanic acid, tigecycline, and imipenem. The resistance rates of A. baumannii in non fermenting bacteria against ceftazidime, cefotetan and ampicillin/sulbactam were also increased year by year. In addition, the resistance rate of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative staphylococcus (MRCNS) were 46.32% and 75.45%, respectively. The resistance rates of methicillin resistant Staphylococcus aureus and coagulase negative Staphylococcus against most penicillins and compound neoforman were on the rise, but no vancomycin resistant Staphylococcus was found. Conclusion From 2017 to 2019, the drug resistance rate of K. pneumoniae, A. baumannii, and E. coli in the clinical pathogens of the Affiliated Hospital of Jiangnan University increased year by year, while the drug resistance rate of other monitoring bacteria was relatively stable. Therefore, the microorganism room and the hospital infection department should regularly monitor the drug resistance of various pathogens, and pay attention to the change of drug resistance, so as to provide theoretical basis for the prevention and treatment of hospital infection, and provide the most appropriate antibiotic treatment scheme for the clinical.

R978.1

無(wú)錫市衛(wèi)計(jì)委科研面上項(xiàng)目（MS201813）