医院感染常见革兰阴性杆菌的耐药性分析

Study on antibiotic resistance of common nosocomial Gram-negative bacteria

目的了解我院2003-2004年间临床分离的常见革兰阴性杆菌的耐药状况,为临床抗感染治疗和合理选择抗菌药物提供依据。方法VITEA-32全自动细菌鉴定仪对临床分离菌株进行鉴定,kirby-Bauer法对临床分离菌株进行药物敏感试验。结果两年间共分离革兰阴性杆菌3262株,占临床细菌总分离率的68.6%。常见的革兰阴性杆菌依次为大肠埃希菌(1021株)、铜绿假单胞菌(609株)、不动杆菌属(575株)、肺炎克雷伯菌(423株)、肠杆菌属(382株)。在大肠埃希菌中,检出产超广谱β-内酰胺酶(ESBLs)349株,产酶率为34.2%;在肺炎克雷伯菌中,检出产ESBLs菌株149株,产酶率为35.2%。药敏结果显示,革兰阴性杆菌对亚胺培南和哌拉西林/他唑巴坦的耐药率较低,对氨苄西林、头孢唑啉、庆大霉素等抗生素具有较高的耐药率,并且多重耐药现象比较严重。结论革兰阴性杆菌的分离率较高,耐药现象严重。临床医生在抗感染治疗中应根据药敏实验结果,合理选择抗菌药物,以提高抗感染的治疗效果。

Objective To analysis the antibiotic resistance of Gram-negative bacteria isolated from Jan2003 to Dec2004 for the guidance of reasonably use of antibiotics. Methods Identification of Gram - negative isolates were done by VITEA-32 autobacteria analysis system. Antibiotic susceptibility tests of chnical isolates were conducted by Kirby-bauer method. Results 3262 stains of Gram negative bacteria were isolated from clinical samples in two years, accounting for 68.6% in total clinical isolates.The common nosocomial Gram negative bacteria were mainly Esehericha coli（ 1021 stains）, Pseudornona aeruginesal （609 stains）, Acinetobaeter（575 stains）, Klebsiella pnenmonea（423 stains）, enterobacer（382 stain） in turn. The ESBLs postive rate of Gram - negative bacteria were 34.2% （349/1021） in E. coli, 35.2% （149/423） in K. pnenmonea, respcctively. Gram negative baceria isolated were sensitive to mipenen and piperacillin/tazobactam,but highly resistant to such antibiotics as ampicillin, gentamycin. And multi - resistance was quite common in Gram- negative bacteria. Conclusion Gram negative bacteria could be isolated from all kind of samples and the rate of multi - resistance is higher for it to most common available antibihics. Therefore, it is very important for physician to promote the rational use of antibiotics, accodding to drug susceptibility tests so as to take effective strategies for infection control.