3775株临床分离革兰阴性菌耐药性分析

Antimicrobial Resistance Analysis Among 3775 Clinical Isolated Gram-negative Bacilli

目的分析我院2006-2007年临床分离革兰阴性菌对抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法采用纸片扩散法对3775株临床分离革兰阴性菌进行药敏试验,结果采用美国临床和实验室标准协会2006年版标准判断,数据统计分析采用WHONET5.4软件。结果两年共收集革兰阴性菌3775株,革兰阴性非发酵菌占36.3%。最常见菌种依次为大肠埃希菌、肺炎克雷伯菌、副流感嗜血杆菌、鲍曼不动杆菌、铜绿假单胞菌、嗜麦芽窄食单胞菌。主要引起呼吸道感染。大肠埃希菌、肺炎克雷伯菌ESBLS的检出率分别为62.7%、42.6%。亚胺培南和美罗培南对肠杆菌科细菌具有较高的敏感性(>94%)。头孢呋辛和头孢曲松对流感嗜血杆菌和副流感嗜血杆菌均具有较高的敏感性(>89%)。鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮/舒巴坦、米诺环素的耐药率在8.8%以下。铜绿假单胞菌对妥布霉素耐药率最低,其次为美罗培南、头孢他啶、阿米卡星、亚胺培南(10.1%～16.1%)。米诺环素对嗜麦芽窄食单胞菌、脑膜炎败血性黄杆菌、产吲哚黄杆菌、洋葱伯克霍尔德菌有较好的抗菌活性(耐药率1.3%～8%)。结论碳青霉烯类对肠杆菌科、鲍曼不动杆菌、铜绿假单胞菌仍保持高活性。根据病原菌的种类及药物敏感性结果合理使用抗菌药物,是有效控制感染和减少耐药菌株产生的重要手段。

OBJECTIVE To investigate the distribution and drug resistance spectrum of clinical gram-negative bacterial isolates in our hospital during 2006-2007 for the guidance of rational use of antibiotics. METHODS Clinical isolates were collected from clinical departments. Drug sensitivity tests were carried out using disc diffusion test, and were analyzed by WHONET 5.4. RESULTS Among 3775 Gram-negative bacterial isolates collected in two years. While 36.3% were Non-fermentative bacteria. The major isolates in the 3775 strains were Escherichia coli, Klebsiella pneumoniae, Haemophilus parainfluenzae, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia. The detection rates of ESBLs to Escherichia coli and Klebsiella pneumonia were 62.7% and 42.6%. The activity of imipenem and meropenem against Enterobacteriaceae was excellent sensitive （〉94%）, while Haemophilus influenzae and Haemophilus parainfluenzae were sensitive to cefuroxime or ceftriaxone（〉89% ）. Acinetobacter baumannii showed the drug-resistant rate below 8.8% to imipenem, meropenem, cefoperazone and minocycline. The most active agent against Pseudomonas aerugionsa was tobramycin, followed by meropenem, ceftazidime, amikacin and imipenem （10.1%-16.1%）.Minocycline was the most active agent to Stenotrophomonas maltophilia, Chryseobacterium meningosepticum,Chryseobacterium indologen, and Burkholderia cepacia （1.3%-8%）. CONCLUSION Carbapenems remained very high activity against Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa.Using the antibiotics reasonably according to the type of pathogenic bacteria and the result of drug sensitivity is effective on infection, and this is an important tool to reduce the form of drug-resistant strains.