下呼吸道多重耐药性革兰氏阴性杆菌监测及临床意义

The surveillance of MRGNB in lower respiratory tract and its clinical significance

目的：监测多重耐药性革兰氏阴性杆菌（ＭＲＧＮＢ），做到合理用药，提高感染治愈率。方法：１９９６年１ 月至１９９７ 年１２ 月，在上海第二医科大学新华医院，临床痰液标本中分离出８４１ 株革兰氏阴性杆菌（ＧＮＢ）。应用美国ＢＥＣＴＯＮ－ＤＩＣＫＩＮＯＮ公司的药敏检测板（ＭＩＣ法），按ＮＣＣＬＳ标准判定敏感性。结果：８４１株ＧＮＢ占同期细菌总数７１．５４％ ，ＧＮＢ中非发酵菌占６９．４６％ ，其中以铜绿假单胞菌最多见，其次为鲍氏不动杆菌。在肠杆菌科中以肺炎克雷伯氏菌最多见，其次为阴沟肠杆菌。多数ＧＮＢ对常用抗生素的耐药率均有不同程度的上升，ＧＮＢ对哌拉西林耐药率高（＞ ６６％ ）。肠杆菌科菌对氨苄西林耐药率更高（９３％ ），对第三代头孢菌素耐药率高达５３％ ～６７％ 。不动杆菌对第三代头孢菌素耐药率高（７５％ ～８４％ ）。铜绿假单胞菌对β－内酰胺类药物耐药率为２２％ ～８６％ 。对ＧＮＢ作用较强者，依次为亚胺培南、阿米卡星、环丙沙星和头孢他啶，上述药物可作为治疗ＧＮＢ感染经验用药的选择。ＭＲＧＮＢ发生率为１７％ ，对４ 类主要抗菌药（氨基糖苷类、喹诺酮、第三代头孢菌素及亚胺培南）中的２类产生耐药性为１０％ ，３ 类产生耐药性为６％

Aim: To improve the curative ratio of infection by monitoring the multiple resistance Gram negative bacilli (MRGNB). Method: In Xinhua Hosptial attached to Shanghai No2 Medical University, during the period from January 1996 to December 1997, 841 strains of GNB are separated from the clinical sputum samples by means of MIC of American BECTON DICKENSON, and the sensitivity is determined with the NCCLS standard. Result: The GNB in the 841 strains comes to 71.57% in the total bacteria for the period, and 69.46% of the GNB is the nonzymophyte, in which Pseudomonas aeruginosa is most commonly found, and Acinetobacter baumanii comes next to it. In the Enterebacteriaceae, the commonest is the Klebsiella pneumoniae and Enterobacter comes second. Most of the GNB show the increase with different degrees in the resistance to antibiotics in common use. The resistance of the GNB to piperacillin is higher than 66%; the resistance of Enterobacteriaceae to ampicillin reaches 93%, and to the third generation cephalosporins comes to 53%~67%. The resistance of Acinetobacter baumanii to the third generation cephalosporins is 75%~84%. The resistance of Pseudomonas aeruginosa to lactam drugs is 22%~86%. The effective drugs against GNB are arranged, in the increasing order of the curative effect, as follows: imipenem, amikacin, ciprofloxacin and ceftazidime. The four drugs mentioned above can be used in the empirical treatment of the GNB infections . The incidence rate of MRGNB is 17%. The resistance to the 2 drugs in the four main antibiotics (aminoglycosides, quinolones, the third generation cephalosporins and imipenem) is 10%; to the three, 6%; to the four, 1%. Escherichia coli, Pseudomanas aeruginosa and Acinetobacter baumanii show 'overall' resistance strains to the antibiotics. Conclusion: 1.The problem of MRGNB are prominent in the teaching hospitals in big cities. The major preventive measure is to control and cut down the use of antibiotics. 2.The resistance of GNB to lactam drugs, esp to ceftaizidime, imipenem, aztreonam, is increasing significantly. 3.GNB shows resistances to ceftazidime, ciprofloxacin and aminolycosides, imipenem which is still highly sensitive to them, can be used as one of the drugs in the treatment of the serious and complex infection of GNB. 4.The synergistic action of lactam drugs with aminoglycosides or quinolones to improve the efficacy on GNB, and to decrease the resistance against strains is to be further studied.