某院2010年革兰阴性杆菌分布及耐药性监测

Surveillance of distribution and antimicrobial resistance in gram-negative bacilli isolated from our hospital in 2010

目的了解我院2010年临床分离革兰阴性杆菌分布及耐药性,为临床合理使用抗菌药提供参考依据。方法用常规方法分离鉴定细菌,K-B法进行药敏试验,数据分析采用WHONET5.4软件。结果 1 996株革兰阴性杆菌主要以大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌和阴沟肠杆菌为主,分别占34.3%、15.2%、13.3%、13.1%和6.0%。肺炎克雷伯菌、产酸克雷伯菌、奇异变形杆菌中产ESBLs株检出率分别为64.6%、50.8%、33.3%和17.1%。药敏实验结果显示肠杆菌科细菌中不同菌种对碳青霉烯类抗菌药仍呈敏感,耐药率<5%,其次为2种β-内酰胺酶抑制剂复方,耐药率大多低于20%。铜绿假单胞菌对阿米卡星、头孢哌酮/舒巴坦、头孢吡肟和头孢他啶的耐药率较低,均不到30%。鲍曼不动杆菌仅对米诺环素和头孢哌酮/舒巴坦较为敏感,分别为18%和27%。结论我院肠杆菌科细菌对碳青霉烯类抗菌药仍较敏感,非发酵菌对多种抗菌药高度耐药。

Objective To investigate the distribution and antimicrobial resistance among nosocomial gram-negative bacilli isolated from our hospital in 2010.Methods All strains were isolated and identified by routine methods.The susceptibility of antimicrobial agents were tested by Kirby-Bauer method.The data were analyzed by WHONET5.4 software.Results 1996 stains Gram-negative bacill were isolated from the clinical samples,of which E.coli,P.aeruginosa,Acinethobacter,K.pneumoniae and E.cloacae were the leading Gram-negative bacill,accounting for 34.3%、15.2%、13.3%、13.1% and 6.0%,respectively.The prevalence of extended-spectrum ？-lactamases（ESBLs） was 64.6% in E.coli,50.8% in K.pneumoniae,33.3% in K.oxytoca and 17.1% in P.mirabilis,respectively.Susceptibility results showed that different strains of Enterobacteriaceae continued to show very high sensitively to carbapenem,resistance rates were only under 5%,followed by two kinds of β-lactamase inhibitor,resistance rates are mostly below 20 %.Resistance rates of Pseudomonas aeruginosa to amikacin,cefoperazone / sulbactam,cefepime and ceftazidime were not to 30%.To Acinetobacter baumannii,only minocycline（18%） and cefoperazone / sulbactam is（27%） more sensitive.Conclusion Carbapenems remain highly active against Enterobacteriaceae.The nonfermentative gram-negative bacilli are highly resistance to most antimicrobial agents.