2002年至2005年临床分离的革兰氏阴性杆菌耐药监测研究及对策

Drug resistance study of gram - negative bacteria

目的 探讨本地区革兰氏阴性杆菌耐药情况，为临床合理使用抗生素提供实验依据。方法 对我院近4年分离的革兰氏阴性杆菌的耐药情况及其变迁、抗生素应用情况进行回顾性分析。结果 所分离菌株耐药率较高的是氨苄西林（87．15％）、头孢拉啶（78．2％）、头孢呋辛（70．3％）、哌拉西林（62．6％）、头孢噻肟（61．2％）、复方新诺明（77．3％）。对亚胺培南、阿米卡星、哌拉西林／他唑巴坦、头孢西丁、呋喃妥因、左旋氧氟沙星、头孢他啶的耐药率依次为4．17％、13．9％、21．0％、23．7％、32．7％、36．7％、38．1％，较其他抗生素为低。铜绿假单胞菌对亚胺培南、头孢他啶、庆大霉素、阿米卡星、哌拉西林的耐药率逐年明显增高。结论 革兰氏阴性杆菌耐药日益严重，并出现多重耐药。应该在药敏结果指导下用药，适当控制抗生素应用，并注重抗生素以外的其它治疗。

Objective To study drug resistance status of Gram -negative bactria at our area and provide evidence for doctor to apply antibiotics reasonably. Methods A total of 2958 Gram -negative strains were collected from clinical specimens during the last four years. Drug resistance status and changes, and antibiotics therapy of Gram - negative bactria were analyzed retrospectively. Results In drug sensitivity result, the resistance rate of ampicillin, cephalothin, cefuroxime, piperacillin, cefotaxime and trimethoprim/sulfamethoxazole were 87.15% , 78.2% , 70.3% , 62.6% , 61.2% , 77.3% respectively. The resistance rate of imipenem, amikacin, piperacillin/tazobactam, cefoxitin, furantoin, levofloxacin, and ceftazidime were 4. 17%, 13.9% ,21.0% ,23.7% ,32.7% ,36.7% ,38.1% respectively. The resistance rate was lower than other antibiotics, ampicillin showed the highest resistance rate（87.15% ）. As far as Pseudomonas aeruginosa was concerned, imipenem, cefiazidime, gentamycin, amikacin and piperacillin showed increasing resistance trend year by year. Conclusion Drug resistance of Gram - negative bactria is increasingly severely, and showes muihiple drug resistance. Antibiotics should be applied according to the result of drug sensitivity, and controlled appropriately, and pay attention to other therapy except for antibiotics.