下呼吸道感染革兰阴性杆菌的耐药现状分析

Antibiotic Resistance in Nosocomial Infections with Gram-negative bacilli from Lower Respiratory Tract

目的了解医院下呼吸道感染主要病原菌的分布及其耐药性,指导临床合理使用抗菌药物。方法 617株革兰阴性杆菌采用法国生物梅里埃公司VITEK全自动微生物分析系统和GNI鉴定卡进行菌种鉴定;采用K-B法进行药敏试验,按照美国临床实验室标准化研究所2007年版操作和判读结果。结果分离率居前6位的革兰阴性杆菌依次为:铜绿假单胞菌(43.3%)、鲍氏不动杆菌(15.9%)、肺炎克雷伯菌(15.4%)、大肠埃希菌(8.2%)、嗜麦芽寡养单胞菌(8.2%)、肠杆菌属(4.0%);以上菌株对常用抗菌药物均产生了严重的耐药性,产超广谱β-内酰胺酶细菌总检出率为54.1%;铜绿假单胞菌和鲍氏不动杆菌泛耐药菌株检出率分别为3.4%和6.1%。结论下呼吸道感染多为多药耐药菌,应熟悉细菌耐药特点及耐药机制,根据病原学检查结果合理选用抗菌药物。

OBJECTIVE To study the pathogens distribution and drug-resistance status of Gram-negative bacilli from lower respiratory tract in our hospital and guide clinically rational use of antibiotics.METHODS A total of 617 strains of Gram-negative bacilli were identified by VITEK auto-microbiological assay and GNI identification card.According to CLSI 2007,the antibiotic susceptibility tests were performed by K-B method and the results were judged.RESULTS The top six of isolating rates of Gram-negative bacilli were Pseudomonas aeruginosa（43.3%）,Acinetobacter baumannii（15.9%）,Klebsiella pneumoniae（15.4%）,Escherichia coli（8.2%）,Stenotrophomomas maltophilia（8.2%） and Enterobacter（4.0%）.Serious drug resistance to commonly used antibiotics occurred in above strains.The total detection rate of extensive-spectrum beta-lactamases（ESBLs） producers was 54.1%.The detection rate of pan-drug resistant strains in P.aeruginosa and A.baumannii was 3.4% and 6.1%,respectively.CONCLUSIONS Gram-negative bacilli from lower respiratory tract are mostly multidrug resistant strains.We should have a knowledge of characteristic and mechanism of drug resistance and choose reasonably antibiotics according to etiology.