目的: 分析2015 年内蒙古医科大学附属医院分离细菌对多种抗菌药物的耐药性。方法: 采用手工
药敏纸片扩散法和法国生物梅里埃全自动鉴定药敏仪器分析了多种抗菌药物的耐药性，参照了2015 年CLSI 判
定标准，分析了抗菌药物的药敏试验结果，采用WHONE 5．6软件统计分析。结果: 鉴定了全院临床分离的3788
株细菌，其中G－ 菌占74．2%( 2809 /3788) ，G+ 菌占25．8%( 979 /3788) 。前五位的临床分离菌株为大肠埃希菌、肺
炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌、铜绿假单胞杆菌。肠杆菌科细菌中产超光谱β 内酰胺酶的肺炎克
雷伯菌和大肠埃希菌的检出率为13．5%和51．1%，肠杆菌科细菌对碳青霉烯类抗菌药物耐药率较低，为2%。非
发酵革兰氏阴性杆菌所占比列为27．8%( 781 /1975) ，主要为铜绿假单胞杆菌和鲍曼不动杆菌，对亚胺培南的耐
药率分别为27．9%和46．1%。耐甲氧西林葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌分别为28．6%( 182 /446) 和
80．7%( 213 /265) ，未检出万古霉素和利奈唑胺耐药的葡萄球菌。肠球菌中屎肠球菌的耐药率远高于粪肠球菌，
未发现对万古霉素和利奈唑胺耐药的肠球菌。肺炎链球菌占革兰氏阳性球菌的6．3%( 62 /979) ，其中对红霉素、
四环素和复方新诺明的耐药率均高于90%。流感嗜血杆菌和卡他布兰汉菌产β－内酰胺酶的检出率分别为
48．7%( 19 /40) 和96．1%( 50 /52) 。结论: 细菌的耐药性问题仍然对临床抗感染治疗起着严重威胁，定期进行细菌
的耐药性监测能够指导临床合理使用抗菌药物，同时有助于了解医院细菌耐药性迁移特征，避免耐药株的扩散
传播。

Objective: To investigate the antimicrobial resistance of clinical bacterial isolates in Inner
Mongolia object to investigate the antibiotic resistance of clinical isolates collected from the Affiliated
Hospital Inner Mongolia Medical University in 2015．Methods: The data was analyzed by WHONET
5．6software according to 2015 edition of antimicrobial susceptibility testing standards issued by The
Clinical and Laboratory Standards Institute( CLSI) of the United States．Discdiffusion test( Kirby－Bauer
method) and automated systems were employed to detect the antimicrobial resistance．Ｒesults: A total of
3788 non － duplicate clinical isolates，Gram negative bacilli and gram positive cocci accounted for
74．2%( 2809 /3788) and 25．8%( 979 /3788) ， respectively．The top five common bacteria were: Escherichia
coli，Klebsiella pneumonia，Staphylococcus aureus，Acinetobacter baumannii，Pseudomonas aeruginosa．
As a member of Enterbacteriaceae spp， the prevalence of extended－spectrum β－laetamases producing
stain was 51．1%of E．coli and 13．5%of K．pneumoniae．Enter bacteriaceae strains were still highly
susceptible to carbapenems，with an overall resistance rate of 2%． The prevalence of extensively －
resistant strains in A．baumannii and P．aeruginosa were 27．8%( 781 /3788) ．The resistance rates of P．
aeruginosa and A．baumannii to imipenem were 27．9%and 46．1%， respectively．Among Staphylococcus
aureus and Staphylococcus isolates，methicillin－resistant Staphyloccus aureus( MＲSA) and methicillinresistant
coagulase － negative Staphylococcus ( MＲCNS) accounted for 28．6% ( 182 /446) and 80．2%
( 213 /265) ， respectively．No staphylococcal strain resistant to vancomycin， teicoplanin，or linezolid was
detected．The resistance rate of E． faecium strains to most of the antimicrobial agents tested ( except
Chloramphenicol) was much lower than that of E．faecalis．No linezolid and vancomycin resistant Enterococcus
strains was found． S． pneumonia of gram positive cocci was 6．3%( 62 /979) ，and its resistance
rates to erythromycin，clindamycin， tetracycline and trimethoprim/sulfamethoxazole were all higher than
90%．There were 48．7%( 19 /40) H．influenzae，and 96．1%( 50 /52) B．catarrhalis which produced β－lactamase．
Conclusion: Antibiotic resistance may still pose a serious threat to clinical practice．Ｒational use
of antibiotics should be required to prevent the spread of antimicrobial resistant strains．

Ｒ378

 收稿日期: 2017－05－08; 修回日期: 2017－10－15
基金项目: 内蒙古医科大学科技百万基金项目: YKD 2016 KJBW( LH) 009
作者简介: 王艳艳( 1983－) ，女，内蒙古医科大学附属医院初级检验师，医学硕士。
通讯作者: 韩艳秋，主任医师，E－mail: nmghyq@ 126．com 内蒙古医科大学附属医院检验科， 010050