678株革兰阴性杆菌的耐药监测分析

Analysis on Drug Resistance Surveillance of 678 Strains of Gram-negative Bacilli

目的监测2008-2009年韶山医院临床分离的革兰阴性杆菌的耐药性。方法采用湖南长沙天地人生物科技有限公司的细菌分析系统和生化及药敏试验卡对678株革兰阴性杆菌进行耐药性监测,并对结果进行回顾性分析。结果 678株革兰阴性杆菌中,肠杆菌科424株(62.54%),较常见的为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌;不发酵糖的革兰阴性杆菌254株(37.46%),较常见的为铜绿假单胞菌、鲍曼不动杆菌。这些菌株对临床常用抗生素有不同程度的耐药,且呈多重耐药趋势;亚胺培南是最敏感的抗革兰阴性杆菌的药物之一;大肠埃希菌的ESBLs发生率高达47.2%。结论大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、鲍曼不动杆菌是临床感染的主要革兰阴性病原菌,其耐药性呈多重耐药趋势,大肠埃希菌的ESBLs发生率高达47.2%,明显高于2003年一项全国性监测[2],此数据显著高于上海地区的报道(33.6%)[3],两者差异有统计学意义(χ2=11.3,P<0.05),故合理应用抗生素和持续有效地开展药敏监测非常必要。

Objective To monitor the drug resistance of gram-negative bacilli isolated from Shaoshan Hospital during the period of 2008～2009. Methods The drug resistance of 678 strains of gram-negative bacilli was monitored using bacteria analysis system and drug sensitivity testing card.The testing results were retrospectively analyzed. Results Among 678 strains of gram-negative bacilli,62.54% of them were Enterobacteriaceae（424/678）,including Escherichia coli,Klebsiella pneumoniae,and Enterobacter cloacae;and 37.46% of them were non-fermenting gram-negative bacilli（254/678）,including Pseudomonas aeruginose and Acinetobacter baumannii.These strains showed resistant to commonly used antimicrobial agents,moreover,there was multi-drug resistant tendency among them.Imipenem was the most sensitive antibiotic agent against gram-negative bacilli.The incidence of ESBLs was up to 47.2% in Escherichia coli. Conclusions Escherichia coli,Klebsiella pneumoniae,Enterobacter cloacae,Pseudomonas aeruginose,and Acinetobacter baumannii were the main gram-negative pathogens that causea infection in clinic,and moreover,they showed a multi-drug resistant tendency.The incidence of ESBLs was up to 47.2% in Escherichia coli,which was significantly higher than that of national surveillance in 2003 and the reported data in Shanghai Area（33.6%）,and the difference was statistically significant（χ2=11.3,P0.05）.The results suggest that it is necessary to rationally use antibiotic agents and constantly and effectively conduct drug resistance surveillance.