临床分离531株革兰阴性杆菌的分布与耐药性分析

Distribution and drug resistance analysis of clinically isolated 531 strains of gram-negative bacilli

【目的】了解从临床患者分离的革兰阴性杆菌的分布及其耐药性特征,指导临床合理使用抗菌药物。【方法】用药敏纸片法对我院2005年1月-2005年12月各类感染标本中分离的革兰阴性杆菌共531株进行药敏试验和用表型确证试验进行ESBLs的检测。【结果】我院分离的革兰阴性杆菌主要为大肠埃希菌(36.3%)、铜绿假单胞菌(23.0%)、肺炎克雷伯菌(14.7%)。这些菌株对12种抗生素的敏感率各不相同,亚胺培南仍是对革兰阴性杆菌抗菌作用最强的一类抗生素,头孢哌酮/舒巴坦、哌拉西林/他唑巴坦也有较好的抗菌活性。大肠埃希菌和肺炎克雷菌ESBLs的检出率分别为26.9%和38.5%。产酶菌株对抗菌药物的敏感率显著降低。【结论】我院分离的革兰阴性杆菌耐药性强且多重耐药,临床实验室应加强对ESBLs的检测,了解各菌种的耐药特点,指导临床合理使用抗菌药物并严密监控新的耐药菌的产生。

[Objective] To investigate the distribution and drug resistance of gram-negative bacilli from the clinical specimen, for the rationalized use of antibiotics in clinical practice. [ Methods] Anti-microbial susceptibility test was done on 531 strains of gram-negative bacilli isolated in our hospital from January 2005 to December 2005 by Kirby-bauer method, the detection of ESBLs-producing strains was performed for screening and confirming the presence of ESBLs. [ Results] The primary proportion of gram-negative bacilli was Escherichia coli 36.3%, Pseudomonas aeruginosa 23.0%, Klebsiella pneumoniae 14.7 %. The susceptibility of these strains were different in 12 antibacterials. Imipenem was the most active antibiotics against gram-negative bacilli, cefoperazone/sulbactam and piperacillin/tazobactam also showed excellent activity. ESBLs producing strains were detected in 26.9% of Escherichia coli and 38.5% of Klebsiella pneumoniae, the susceptibility was remarkablly lower than those of ESBLs negative strains. [Conclusions] Drug resistance of gram-negative bacilli was high and multiple in our hospital. The importance of detecting extended ESBLs occurrence in clinical lab, helping rationalize antibiotic use in clinical practice.