我院近3年下呼吸道革兰阴性杆菌耐药性监测

Bacterial resistance surveillance of gram-negative bacilli over recent 3 years in the hospital

目的调查我院近3年下呼吸道革兰阴性杆菌的耐药情况。方法使用MIC法对我院下呼吸道感染住院患者的痰液标本中临床分离的926株革兰阴性杆菌进行药敏试验，并用WHONET5．4软件进行数据分析。结果926株革兰阴性杆菌中最常见的菌种依次为大肠埃希菌（29．7％）、肺炎克雷伯菌（23．7％）、铜绿假单胞菌（14．3％）、鲍曼不动杆菌（12．1％）。大肠埃希菌、肺炎克雷伯菌对多黏菌素B、亚胺培南、美罗培南和咪诺环素保持高度敏感，耐药菌率在10％以内，对阿米卡星、哌拉西林／三唑巴坦、头孢哌酮／舒巴坦、头孢他啶及头孢匹肟的耐药率为30％以内，对其余所检测药物的耐药率均在30％以上。铜绿假单胞菌对多黏菌素B和咪诺环素；而亚胺培南、美罗培南、哌拉西林／三唑巴坦、头孢哌酮／舒巴坦和阿米卡星耐药率低于30％；鲍曼不动杆菌耐药情况比较严重，只有多黏菌素B、头孢哌酮／舒巴坦高度敏感，耐药率在10％以内，对亚胺培南和美罗培南的耐药率在20％以内，对其余所检测药物的耐药率均在30％到60％以上。结论本研究结果对我院革兰阴性杆菌感染的经验用药治疗有重要参考价值。

Objective To investigate the bacterial resistance of gram-negative bacilli isolated from lower respiratory tract in the hospital. Methods Antimicrobial susceptibility of 926 gram-negative bacilli isolates collected from the sputum specimen of the inpatients in the hospital who had lower respiratory tract infection was tested by MIC method, and the data were analyzed by WHONET 5.4. Results Among the total 926 gram-negative bacilli isolated, the most common species were E. coli （29.7%）, K. pneumoniae （23.7%） ,P. aeruginosa （14.3%） and A. baumannii （12.1%）. The drug resistance rates of E. coli and K. pneumoniae isolate to Polymyxin 13,imipenem,meropenem and Minocycline were all less than 10 %. The drug resistance rates of E. coli and K. pneumoniae isolate to amikacin, piperacillin/tazobactam, cefoperazone/ sulbactam,ceftazidime and cefepime were all less than 30%. The drug resistance rates of E. coli and K. pneumoniae isolate to other test drugs were all above 30 %. The drug resistance rates of P. aeruginosa isolate to polymyxin 13, imipenem and meropenem, cefoperazone/sulbactam, minocycline and amikacin were all less than 30%. The isolates of A. baumannii were susceptible to polymyxin 13 and cefoperazone/sulbactam. The drug resistance rates of A. baumannii isolate to imipenem and meropenem were all less than 20%. but their resistant rate stood at 30% to cefepim and above 60% to other test drugs. Conclusions The data may have great significance in the empirical use of antimicrobial agents for the treatment of infections caused by gram- negative bacilli in the hospital.