青岛地区革兰阴性杆菌的分布及耐药性监测

Distribution and Antibiotic Resistance of Gram-negative Bacilli in Qingdao:A Surveillance

目的了解青岛地区常见革兰阴性杆菌的种类、分布及耐药状况,为临床用药提供依据。方法收集青岛地区4所医院临床分离的2362株革兰阴性杆菌,采用ATB Expression自动细菌鉴定系统对菌种进行鉴定,用K-B法进行药物敏感性实验。结果分离出的革兰阴性杆菌中,主要以大肠埃希菌（ECO）、铜绿假单胞菌（PAE）、肺炎克雷伯菌（KPN）、不动杆菌属（AC-）、阴沟肠杆菌（ECL）多见;大多数革兰阴性杆菌对广谱青霉素、第三代头孢菌素、氨基糖苷类和喹诺酮类抗菌药物的耐药率高;头孢吡肟（FEP）对革兰阴性非发酵菌抗菌作用差,对肠杆菌科细菌耐药率较低,为17.5%-33.9%;头孢哌酮/舒巴坦（CFS）和哌拉西林/他唑巴坦（TZP）对革兰阴性杆菌的抗菌作用强,耐药率分别为9.9%-24.6%和9.3%-29.2%;亚胺培南（IMP）对革兰阴性杆菌的抗菌活性最强,除PAE外,细菌耐药率均〈5%。结论革兰阴性杆菌对常用抗菌药物耐药性较高,开展地区性细菌耐药监测十分重要。

OBJECTIVE To investigate the distribution and resistance of Gram-negative bacilli in Qingdao and for offering reasonable evidence to antibiotics therapy. METHODS Totally 2362 strains of Gram-negative bacilli were collected from 4 hospitals in Qingdao. The identification was analyzed by ATB Expression automatic microbiology analytical instrument system. The bacterial susceptibility test was done by Kirby-Bauer agar diffusion method. RESULTS Among 2362 isolates, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneurnoniae, Acinetobacter spp, and Enterobacter cloacae were the main. Most of Gram-negative bacilli were high resistant to broadspectrum penicillins, third-generation cephalosporins, aminoglycosides and quinolones. Cefepime had less activity against nonfermentative Gram-negative organisms and low resistant to Enterobacteriaceae bacteria （17.5-33.9%）. Cefoperazone/sulbactam and piperacillin/tazobactam showed greater activity against Gram-negative bacilli, their resistant rates were 9.9-24.6% and 9.3-29.2%, respectively. Imipenem was the most active agent against Gram- negative bacilli （except Pseudornonas aeruginosa）, the resistant rates were 0-4.9%. CONCLUSIONS Resistance rates of Gram-negative bacilli are high. It is urgent to establish a regional surveillance system on bacterial resistance.