目的 探讨2017-2019年江南大学附属医院临床病原菌的分布及耐药性，为临床合理选用抗感染治疗用药提供参考依据。方法 采用法国生物梅里埃全自动化药敏仪器法或纸片扩散法（K-B法）进行抗菌药物敏感性试验，并回顾性分析2017-2019年江南大学附属医院临床病原菌的分布情况及耐药性。结果 共分离出病原菌17 908株，其中革兰阴性菌11 887株，占66.38%，主要为铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和鲍曼不动杆菌；革兰阳性菌5 402株，占30.17%，主要分布为金黄色葡萄球菌、肠球菌属、凝固酶阴性葡球菌和链球菌属；真菌619株，占3.46%，主要为白假丝酵母菌和热带假丝酵母菌。大肠埃希菌和肺炎克雷伯菌对替卡西林、头孢唑啉、哌拉西林的耐药率均达100%，且对其他药物的耐药率也是逐年上升；肠杆科病原菌对阿米卡星、阿莫西林/克拉维酸、替加环素、亚胺培南等药物较敏感；非发酵菌中鲍曼不动杆菌对头孢他啶、头孢替坦、以及氨苄西林/舒巴坦的耐药率也是逐年上升趋势。耐甲氧西林金黄色葡萄球菌（MRSA）的耐药率为46.32%、耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的耐药率为75.45%。耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌对大多数青霉素类以及复方新诺明等相关药物的耐药率呈上升趋势，未发现对万古霉素耐药的葡萄球菌。结论 2017-2019年江南大学附属医院临床病原菌中肺炎克雷伯菌、鲍曼不动杆菌以及大肠埃希菌的耐药率呈逐年上升趋势，而其他监测细菌的耐药率则比较稳定。因而，微生物室和医院感染科应定期监测各种病原菌耐药性监测，时刻关注耐药性变迁，从而为医院感染防治提供理论依据，并为临床提供最适宜的抗生素治疗方案。

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

无锡市卫计委科研面上项目（MS201813）