1939株革兰阴性杆菌的耐药监测分析

Antibiotic resistance monitoring among 1939 Gram-negative bacilli strains

目的了解广州华侨医院2007年至2009年分离的1 939株革兰阴性杆菌的耐药状况,为临床合理使用抗生素提供依据。方法利用梅里埃VITEK-2 Compact微生物分析仪鉴定细菌,K-B法进行药敏试验,采用WHONET5.4软件统计分析药敏结果。结果 2007年至2009年分离出的革兰阴性杆菌1 939株,居前3位的细菌分别是铜绿假单胞菌479株、大肠埃希菌452株和鲍曼不动杆菌257株,主要分离自呼吸内科和ICU病房,标本类型以痰液为主,大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌产ESBLs的比例分别为54.8%、43.9%和37.5%,非产ESBLs组细菌对舒普深、复方新诺明、氨基糖苷类、喹诺酮类、青霉素/酶抑制剂类及第三、四代头孢菌素的耐药性明显低于产ESBLs组,非发酵革兰阴性杆菌除对碳青霉烯类抗生素和舒普深较为敏感外（耐药率0.0%~17.0%）,对大多数抗菌药物耐药严重（耐药率31.0%~74.0%）,并且出现多重耐药菌株。结论革兰阴性杆菌耐药现象严重,出现产ESBLs菌株和多重耐药菌株,加强其耐药性监测可指导临床合理选用抗菌药物,同时为临床提供最新的流行病学和耐药性变迁资料。

Objective To investigate the drug resistance of Gram-negative bacilli isolated from the clinical specimen in Guangzhou Oversea Chinese Hospital from 2007 to 2009,so as to guide the reasonable using of antibiotics in clinical practice.Method The bacteria were identified with Bio-Merieue VITEK-2 Compact system and tested with K-B method.Whonet 5.4 software was used to analyze the results of drug sensitivity tests.Result Of the 1 939 Gram-negative bacilli isolated,the top three were Pseudomonas aeruginosa（479 strains）,Esherichia coli（452 strains） and Acinetobacter baumannii（257 strains）.Most of the strains were isolated from Department of Respiratory Medicine and ICU,mainly from sputamentum samples.The prevalence of ESBLs in E.coli,Klebesiella pneumoniae and Proteus mirabilis were 54.8%,43.9% and 37.5%,respectively.ESBLs non-producing strains showed lower resistance rates to sulbactam/cefoperazone,trimethoprim/sulfamethoxazole,aminoglycosides,quinolones,penicillin/enzyme inhibitor,and the third and fourth generation cephalosporin than the ESBLs producing strains.Nonfermentative gram negative bacilli were very highly resistant to most antibiotics（31.0%~74.0%）,while sensitive to sulbactam/cefoperazone and carbapenem.And multidrug resistant strains were detected.Conclusion The antibiotic resistance of the 1 939 gram negative bacilli is critical,with ESBLs producing strains and multidrug resistant strains having been detected.It is very important to select antibiotics correctly according to the results of susceptibility test,which can offer first-hand epidemiology information and dynamic changes of antibiotic resistance for clinical practice.