临床常见革兰阴性杆菌的耐药性分析

Drug Resistance of Clinical Commonly Encountered Gram-negative Bacteria

目的了解医院临床分离的革兰阴性杆菌分布和对常用抗菌药物的耐药情况,从而指导临床经验性用药。方法按照美国临床实验室标准化委员会标准,用K-B法检测2007年7月-2008年12月医院临床分离的常见革兰阴性杆菌对常用抗菌药物的敏感性,采用双纸片确证试验检测大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的阳性率。结果 2007年7月-2008年12月分离常见革兰阴性杆菌5290株,其中铜绿假单胞菌1863株,肺炎克雷伯菌1254株,鲍氏不动杆菌1153株,大肠埃希菌1020株,检出率依次为35.22%、23.71%、21.80%和19.28%,其他革兰阴性杆菌722株;铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌对亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢西丁的耐药率较低,对哌拉西林、环丙沙星等药物的耐药性较高,鲍氏不动杆菌对头孢哌酮/舒巴坦的耐药率为32.70%,而对其余常用抗菌药物的耐药性均>50.00%;大肠埃希菌和肺炎克雷伯菌的ESBLs检出率分别为52.90%和49.20%,并且出现了耐碳青酶烯类抗菌药物的大肠埃希菌和肺炎克雷伯菌。结论鲍氏不动杆菌的耐药现象严重,并呈多药耐药,大肠埃希菌和肺炎克雷伯菌ESBLs检出率较高,应加强监测耐碳青酶烯类抗菌药物的肠杆菌科细菌;为控制医院感染,临床医师应依据药敏试验结果合理选用抗菌药物,提高抗感染的治疗效果。

OBJECTIVE To understand current distribution of common clinical Gram-negative bacteria and their drug resistance in our hospital,to guide empirical clinical medicine.METHODS According to the recommendation of Clinical and Laboratory Standards Institute of the USA,the susceptibility tests of clinical commonly encountered bacteria isolated from Jul of 2007 to Dec of 2008 were performed by using K-B method.The extended spectrum β-lactamase（ESBLs）-produing Escherichia coli and Klebsiella pneumoniae were detected by double disc confirmed test.RESULTS A total of 5290 strains of Gram-negative bacteria were isolated from our hospital,including 1863 strains of Pseudomonas aeruginosa,1254 strains of K.pneumoniae,1153 strains of Acinetobacter baumannii and 1020 strains of E.coli,the detection rates were 35.22%,23.71%,21.80% and 19.28%,respectively,and 722 strains of other Gram-negative bacteria respectively.Results of susceptibility tests demonstrated that the drug resistance rate of P.aeruginosa,K.pneumoniae and E.coli to imipenem,meropenem,piperacillin/tazobactam,cefoperazone/sulbactam and cefoxitin was low,but higher resistance to piperacillin,ciprofloxacin,et al.The resistance rate of A.baumannii to cefoperazone/sulbactam was 32.70%,however,to other antibiotics was above 50%.ESBLs detection rates of E.coli and K.pneumoniae were 52.90% and 49.20%,respectively,and the carbapenem-resistant E.coli and K.pneumoniae strains were also isolated from our hospital.CONCLUSION The drug resistance of A.baumannii is very severe and multi-drug resistant.ESBLs production of E.coli and K.pneumoniae is very high,and the surveillance for carbapenems resistance should be enhanced.In order to control the hospital acquired infection,the antimicrobial agents should be reasonably used according to results of susceptibility tests,and to improve the therapeutic effect of anti-infection.