常见革兰阴性菌耐药性变迁临床分析

Drug resistant spectrum of common clinical Gram-negative bacteria

目的了解临床常见革兰阴性菌的耐药谱变化趋势,为临床预防和治疗提供依据。方法调查本院2007年1月1日-2009年12月31日住院患者临床送检的痰、尿、血、创面分泌物等标本,对分离得到的细菌采用自动细菌鉴定仪及其配套的鉴定卡和药敏卡,根据微量稀释法所测MIC值以判定其对抗菌药物的耐药情况,结果按NCCLS2003标准判断。结果亚胺培南和阿米卡星是本院治疗革兰氏阴性菌较有效的药物:大肠埃希菌和肺炎克雷伯杆菌对舒普深、头孢西丁、哌拉西林/他唑巴坦较敏感;铜绿假单胞菌对头孢吡肟、头孢他啶和妥布霉素较敏感;鲍曼不动杆菌最近两年对各种抗生素耐药性上升明显,ICU出现较多多重耐药菌株。结论临床医生要及时掌握临床上细菌耐药谱的变化,合理使用抗生素,防止院内交叉感染的发生。

Objective To investigate the trend of drug resistant spectrum of Gram-negative bacteria and provide guidance for clinical medication and prevention. Methods The samples of sputum, urine, blood and secretion of raw surface were collected in Tenth People＇s Hospital from January 2007 to December 2009. All pathogens isolated from the samples were identified with auto SCAN-4 equipment for bacterium analysis. Drug resistance test was carried out and the results were judged by NCCLS2003. Results Imipenem and Amikacin were the relative effective drugs in the treatment of Gram-negative bacteria in this hospital. Besides, Escherichia coli and Klebsiella pneumoniae were sensitive to sulperazon, cefoxitin and piperacillin/tazobactam. Pseudomonas aeruginosa was sensitive to cefepime, ceftazidime and tobramycin .The resistance of Acinetobacter baumanii to the commen antibiotics increased in these years. Multi-drug-resistant strains appeared in ICU frequently.Conclusidn Clinicians should use antibiotics rationally and pay attention to the prevention of nosocomial infection and cross infection.