呼吸病房下呼吸道感染细菌连续4年耐药性监测

Continuous surveillance on the resistance of bacteria isolated from lower respiratory tract in wards of respiratory disease

目的分析呼吸病房下呼吸道感染患者的致病菌分布及其耐药趋势.方法从2001年～2004年呼吸内科下呼吸道标本中分离致病菌429株,采用VITEK32全自动微生物分析仪鉴定菌种并行敏感性试验,K-B纸片法作补充.结果呼吸病房前5位致病菌为肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌、鲍曼不动杆菌、大肠埃希菌;肺炎克雷伯菌在呼吸道致病菌中所占比例在2001年～2003年有逐年下降趋势,铜绿假单胞菌于2003年跃居第1位(21.1%).抗菌活性最高的是亚胺培南,除对铜绿假单胞菌敏感率略低(86.6%)外,对其它菌株敏感率均在97.4%以上,妥布霉素和奈替米星的平均敏感率为79.6%和78.8%,头孢他啶的平均敏感率为74.7%.大肠埃希菌对第三代头孢菌素头孢噻肟和头孢他啶的耐药率逐年同幅增长,4年耐药率依次为25%、46.2%、75%和77.8%.4年间耐药性增长较快的是鲍曼不动杆菌和铜绿假单胞菌.对于阴沟肠杆菌,体外活性最好的是亚胺培南,其次是氨基糖苷类抗生素.结论革兰阴性杆菌是呼吸病房内下呼吸道感染的主要致病菌,非发酵菌所占比例及其耐药性均有增长趋势,亚胺培南对易产超广谱β-内酰胺酶和AmpC酶的菌株活性高,耐药监测对指导和帮助临床合理选择抗生素具有重要意义.

Objective To analyze the surveillance data on bacterial resistance in respiratory disease wards reported from 2001 to 2004.Methods 429 strains of bacterial were isolated from lower respiratory tract specimens.VITEK 32 and Kirby-Bauer method were used for the identification and bacterial susceptibility test.Results The most common pathogens were Klebsiella pneumoniae,Pseudomonas aeruginosa,Enterobacter cloacae,Acimetobacter baumanni and Escherichia coli.The prevalence of Klebsiella pneumoniae in the wards was decreased,otherwise the percentage of Pseudomonas aeruginosa increased to the first rank (21.1%) in 2003.The most active antibiotics for 3 years was imipenem (with a susceptibility rate of 86.6% to 100%),followed by tobramicin (79.6%),netilmicin (78.8%),and ceftazidime (74.7%).From 2001 to 2004,resistant rates of Escherichia coli against the third generateon cephalosporins (cefotaxime,ceftazidime) had increased markedly which was 25% in 2001,46.2% in 2002,75% in 2003,and 77.8% in 2004,respectively.The antimicrobial resistance of Pseudomonas aeruginosa and Acimetobacter baumanni had also increased.To Enterobacter cloacae,the most active antibiotic was imipenem,followed by aminoglycoside antibiotics.Conclusions Nosocomial gram-negative bacilli were the most common pathogens in the patients with lower respiratory tract infection in respiratory disease wards.The prevalence and antimicrobial resistance of nonfermenting gram-negative bacilli have increased obviously.Imipenem remains highly active against ESBLs and AmpC producing strains.It is rational to select sensitive antibiotics according to the results of continuous surveillance of antimicrobial resistance.