2000—2009年血流感染革兰阴性杆菌的构成及耐药性

The distribution and drug-resistance of Gram-negative bacilli among bloodstream infection during 2000—2009

目的了解血流感染革兰阴性杆菌的构成及耐药性。方法使用BACTEC9120全自动血培养仪及MicroScan WalkAway-40全自动细菌鉴定/药敏分析仪对血液标本进行培养、鉴定和药敏试验,并采用SPSS 13.0软件进行统计分析。结果 2000年1月-2009年12月血流感染中共分离革兰阴性杆菌676株,其中大肠埃希菌40.2%、肺炎克雷伯菌19.1%、沙门菌属9.6%、铜绿假单胞菌7.4%、阴沟肠杆菌4.1%和鲍曼不动杆菌3.0%。大肠埃希菌和肺炎克雷伯菌对亚胺培南的敏感率93%～100%、阿米卡星均81%～94%、哌拉西林/三唑巴坦76%～92%、三代头孢菌素和氨曲南均由2001～2003年的76%降低到2007～2009年的约30%和42%;阴沟肠杆菌对亚胺培南、阿米卡星、环丙沙星的敏感率分别为100%、82%和59%,对三代头孢菌素和氨曲南的敏感率均小于30%。铜绿假单胞菌对亚胺培南、妥布霉素和环丙沙星的敏感率为79%、阿米卡星75%、哌拉西林/三唑巴坦62%、哌拉西林58%、氨曲南54%、头孢他啶50%,对头孢吡肟的敏感率由2001-2003年的80%降低到2007-2009年的42%;鲍曼不动杆菌对亚胺培南的敏感率50%。结论血流感染革兰阴性杆菌敏感率较低,大肠埃希菌分离率最高。应加强血流感染革兰阴性杆菌及其耐药性检测。

Objective To know the species distribution and drug-resistance of Gram-negative bacilli among bloodstream infections（BSI）. Methods The BACTEC9120 blood culture system was used for blood culturing and MicroScan WalkAway-40 system was used for identification and antibiotics susceptibility tests. SPSS13.0 was used to perform the statistical analysis. Results During Jan 2000 to Dec 2009, 676 Gram-negative bacillis were detected among bloodstream infections. Escherichia coli accounted for the majority （40.2%）, other species were Klebsiella pneumoniae （19.1%）, E. cloacae （4.1%） and Acinetobacter baumannii （3.0%）, respectively. E. eoli and K. pneumoniae more sensitive to impenem（93%-100%）, amikacin （81%-94%） and piperacillin-tazobactam （76%-92%）. But their susceptible rate to aztreonam and the 3th cephsporins decreased to 30% and 42% during 2007 to 2009, which were all 76% during 2001 to 2003. About 100%, 82% and 59% of Enterobacter cloacae were susceptible to impenem, amikacin and ciprofloxacin respectively, which were less than 30% to 3th cephsporins and atreonam. Susceptible rates of Pseudomonas aeroginosa to impnem, tobramycin and ciprofloxacin were all 79%, and to amikacin, piperacillintazobactam, piperacillin, atreonam and ceftazidime were 75%, 62%, 58%, 54% and 50% respectively. But its susceptible rate to cefepime decreased from 80% （2001 to 2003） to 42% （2007 to 2009）. 50% of Acinetobacter baumannii were susceptible to impnem. Conclusions Gram-negative bacilli had low susceptibilities among BSI. E. coli was the most common pathegon, among BSI. It is important to enstrength the identification and drug-resistance tests of Gram-negative bacilli among BSI.