下呼吸道感染患者革兰阴性杆菌耐药性分析

Drug Resistance Analysis of Gram-Negative bacillus with Lower Respiratory Tract Infection

目的分析医院下呼吸道感染患者的革兰阴性杆菌细菌构成和耐药情况。方法通过常规细菌培养分析革兰阴性杆菌的分布,并用K-B法测定282株革兰阴性杆菌对14种抗菌药物的耐药率。结果分离率前3位分别为铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌,检出率分别为23.76%、15.96%、12.76%;超广谱β-内酰胺酶(ESBLs)在肺炎克雷伯菌、大肠埃希菌中的检出率分别占35.56%、51.85%;除流感嗜血菌对常用抗菌药物的敏感性较高外,其余革兰阴性杆菌均显示了不同程度的耐药性,鲍氏不动杆菌对头孢菌素类和磺胺甲噁唑/甲氧苄啶的耐药率>50.00%,革兰阴性杆菌对含酶抑制剂的药物哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率均<35.82%,氨基糖苷类药物阿米卡星对几种革兰阴性杆菌耐药率均<26.09%,临床可选择使用。结论应加强革兰阴性杆菌耐药性的动态检测,为临床医师合理使用抗菌药物提供科学依据。

OBJECTIVE To study the antimicrobial resistance of Gram-negative bacilli isolated and their drug-resistant tendency in patients with lower respiratory tract infection.METHODS The bacterial distribution of Gram-negative bacilli was determined using conventional bacterial culture.The resistance rates of 282 Gram-negative bacilli strains were determined by K-B method.RESULTS The Pseudomonas aeruginosa,Klebsiella pneumoniae,and Acinetobactor baumannii,were the top three pathogens.Their detection rate was 23.76%,15.96% and 12.76%,respectively.The detection rate of extended spectrum beta lactamases（ESBLs） producers in K.pneumoniae and Escherichia coli were 35.56 % and 51.85%,respectively.Except for Haemophilus influenzae,the other Gram-negative bacilli were resistant to the routine drugs in different degrees.The resistance rate of A.baumannii to cephalosporins and suefamethoxazole/trimethoprim（cotrimoxazole） was more than 50.00%,the resistant rates of Gram-negative bacilli to the enzyme inhibitors drug containing such as piperacillin/tazobactam,and cefoperazone/sulbactam against were lower than 35.82%,but to amikacin was lower than 26.09%,so it could used for clinical therapy.CONCLUSIONS It is very necessary to monitor pathogens to provide the scientific evidence for clinical usage of the antibiotics.