医院感染革兰阴性杆菌的分布及耐药性分析

Pathogens Distribution and Related Drug Resistance in Nosocomial Infections with Gram-negative Bacilli

目的了解医院革兰阴性杆菌的分布及耐药性，为临床合理使用抗菌药物提供参考依据。方法革兰阴性杆菌分离自2007年1月-2008年12月医院住院患者送检的各类感染性样本、细菌分离、鉴定按《全国临床检验操作规程》进行；药物敏感性试验采用K—B法。结果分离出革兰阴性杆菌358株，分离率居前5位的主要病原菌为大肠埃希菌161株（45．0％）、铜绿假单胞菌52株（16．7％）、肺炎克雷伯菌42株（13．5％）、鲍氏不动杆菌36株（11．6％）、阴沟肠杆菌20株（6．4％）；病原菌检出率较高的科室为神经外科、神经内科、胸外科、呼吸内科；药敏试验显示，革兰阴性杆菌对碳青酶烯类抗菌药物亚胺培南、美罗培南敏感性较高，对其他常用抗菌药物耐药率呈上升趋势。结论革兰阴性杆菌耐药性已十分严重，医院应重视病原学及耐药性检测，预防医院感染暴发流行。

OBJECTIVE To investigate flora distribution and drug resistance status in nosocomial infections with Gram-negative bacilli and provide the scientific evidence for clinically reasonable use of antibiotics. METHODS Gram-negative bacilli were clinically isolated from various infective specimens from the inpatients from Jan 2007 to Dec 2008. The strains isolation, and identification were performed according to National Clinical Laboratory Op- eration Rule. Drug sensitivity testing was performed by K-B methods. RESULTS Among 358 strains of Gramnegative bacilli, the top five of the isolating rate were Escheriehia coli （161, 45.0%）, Pseudomonas aeruginosa （52, 16. 7%）, K. pneumoniae （42, 13. 5%）, A. baumannii （36, 11. 6%） and Enterobacter cloacae （20, 6.4%）. The higher isolating rates of pathogens occurred in department of neurosurgery, department of neurology, department of thoracic surgery and respiratory department. The drug-resistance supervision in vitro manifested that drug resistance rate to the commonly used antibiotics were on the rise except for higher sensitivity to carbopenems such as imipenem and meropenem. CONCLUSIONS Drug resistance status of Gram-negative bacilli is very serious. It should pay attention to the detection of pathogens and drug resistance in hospital to prevent the outbreak.