下呼吸道分离革兰阴性杆菌近3年耐药性监测

Monitoring of antimicrobial resistance in gram-negative bacilli isolated from lower respiratory tract of patients for 3 consecutive years

目的:了解下呼吸道分离革兰阴性杆菌的耐药变迁情况。方法:使用VITEK-AMS60鉴定菌种,采用K-B法进行药敏试验,数据分析采用统计软件SPSS11.5。结果:2006～2008年共分离到1 018株革兰阴性杆菌,鲍曼不动杆菌和铜绿假单胞菌均位于年分离率的前两位,非发酵菌分离率有逐年升高的趋势,而肠杆菌科细菌分离率降低。铜绿假单胞菌和嗜麦芽寡养单胞菌耐药率较高。头孢他啶、头孢吡肟及哌拉西林/他唑巴坦的耐药率升高。肺炎克雷伯菌产ESBLs株检出率升高,大肠埃希菌产ESBLs株检出率下降。产酶株对抗菌药物的耐药率均高于非产酶株。结论:下呼吸道感染最常见的革兰阴性杆菌为非发酵菌及肠杆菌科细菌,细菌耐药性呈现多重耐药趋势。

Objective: To investigate the change patten of antimicrobial resistance among gram-negative bacilli isolated from lower respiratory tract for rational antibiotic therapy in clinical practice.Methods: The strains were identified with VITEK-AMS 60.Antimicrobial susceptibility was tested by disc diffusion(K-B) method.SPSS 11.5 software was used to analyze the data.Results: 1 018 gram-negative bacilli isolated from 2006 to 2008 were identified.The first two separation rate were Acinetobacter baumannii and Pseudomonas aeruginosa.While the separation rate of non-fermentative gram-negative bacilli rose year by year,the separation rate of enterobacteriaceae declined.The drug resistance of Pseudomonas aeruginosa and Stenotrophomonas maltophilia were higher.The resistance to Ceftazidime,Cefepime,Piperacillin/tazobactam rose.The prevalence of extended-spectrum β-lactamses(ESBLs) in Klebsiella pneumoniae increased while in Escherichia coli the prevalence decreased.ESBLs-producing strains were resistant to antibacterial agents than nonESBLs-producing strains.Conclusion: The most common bacilli from lower respiratory tract are non-fermentative gram-negative bacilli and enterobacteriaceae,bacterial resistance presents multi-drug resistance.