临床常见革兰阴性细菌的分布及耐药性分析

The distribution and drug resistance analysis of common gram-negative bacterium in clinic

目的了解院内革兰阴性细菌的分布及耐药性特点。方法收集本院2004年7月～2006年7月各类临床标本分离出的革兰阴性细菌，采用K-B纸片琼脂扩散法进行药敏试验，分析其临床分布及耐药性。结果共分离出1271株革兰阴性细菌，以大肠埃希菌、克雷伯菌属和铜绿假单胞菌为主要病原菌，标本主要分布于痰、咽拭子和尿液中，病区主要集中于ICU室、神经外科和肺科。超广谱β-内酰胺酶（ESBLs）在大肠埃希菌、克雷伯菌属和变形杆菌属的检出率分别为38．4％、31．7％和25．5％。亚胺培南和美罗培南对肠杆菌科细菌、产ESBLs菌株和不动杆菌属的抗菌活性最强，耐药率为0-5．6％，铜绿假单胞菌对两药的耐药率为29．8％和27．2％；嗜麦芽窄食单胞菌对两药物高度耐受，耐药率均为95．7％，但对环丙沙星、头孢哌酮／舒巴坦和替卡西林／克拉维酸较敏感。结论大肠埃希菌、克雷伯菌属和铜绿假单胞菌为本院最常见革兰阴性细菌，亚胺培南和美罗培南对除嗜麦芽窄食单胞菌外的其他革兰阴性细菌具有较好的抗菌活性，其他抗菌药物的抗菌活性相对较低。

Objective To investigate the distribution and drug resistance of gram-negative bacterium in our hospital. Methods Antimicrobial susceptibility of gram-negative bacterium isolated in various kinds of specimens from July 2004 to July 2006 was tested by kirby bauer method. The ditribution and drug resistance were analyzed. Results There were mainly Escherichia coli, Klebsiella spp and Pseudomonas aeuroginosa among 1 271 gram-negative bacterium isolated in two years. The distribution of specimens came mainly from sputum, respiratory secretions and urine. They were gathered from ICU, neurosurgery and pulmonary disease ward. The detection rates of extended spectrum beta-lactamases（ESBLs） producing E. coli, Klebsiella spp and Proteus spp were 38.4%, 31.7% and 25. 5%, respectively. Enterobacteriaceae spp, ESBLs producing strains and Acinetobacter spp were most susceptible to imipenem and meropenem, and the resist- ant rates were from 0 to 5.6%, but those of P. aeuroginosa were 29.8% and 27.2%, respectively. Both the resistant rates of S. maltophilia to imipenem and meropenem were 95.7%, but Stenotrophomonas maltophilia was susceptible to ciprofloxacin, cefoperazone/sulbactam and ticarcillin/clavulanic acid. Conclusion There are mainly E. coli, Klebsiella spp and P. aeuroginosa among gram-negative bacterium in our hospital. Imipenem and meropenem remain highly active against gram-negative bacterium except S. maltophilia. Other antimicrobial agents are less active.