临床常见革兰阴性杆菌的耐药性检测分析

Detection of drug resistance of common clinical gram-negative bacteria

目的了解医院2007-2009年临床分离的革兰阴性杆菌分布及对抗菌药物的耐药性,为临床治疗提供帮助。方法细菌鉴定采用VITEK微生物分析仪,药物敏感试验采用K-B纸片琼脂扩散法,对细菌药敏试验结果进行统计分析。结果 2007年1月-2009年12月分离出常见革兰阴性杆菌2505株,其中大肠埃希菌1280株,铜绿假单胞菌485株,肺炎克雷伯菌385株,鲍氏不动杆菌202株,检出率依次为51.5%、19.4%、15.4%、8.0%,其他革兰阴性杆菌153株;大肠埃希菌和肺炎克雷伯菌对阿米卡星、阿莫西林/克拉维酸、头孢哌酮/舒巴坦的耐药率均<40.0%,对亚胺培南的耐药率<1.0%,对阿莫西林、磺胺甲噁唑/甲氧苄啶耐药率较高,为65.3%～100.0%;铜绿假单胞菌对头孢哌酮/舒巴坦、亚胺培南、头孢吡肟的耐药率较低,均<40.0%,对替卡西林和磺胺甲噁唑/甲氧苄啶耐药率较高,为74.6%～93.5%,鲍氏不动杆菌对头孢哌酮/舒巴坦的耐药率较低,<17.0%;大肠埃希菌和肺炎克雷伯菌的产ESBLs检出率为52.3%和32.9%。结论加强临床病原菌及其耐药性监测,有助于临床合理使用抗菌药物和提高治疗效果。

OBJECTIVE To understand the distribution and drug resistance of the clinical isolates of gram-negative bacilli from 2007 to 2009,so as to provide basis for clinical treatment.METHODS The bacteria were identified by VITEK microbial analyzer,the K-B agar diffusion was used to perform the drug susceptibility testing,then the result of the drug susceptibility testing was statistically analyzed.RESULTS There were 2505 strains of common gram-negative bacilli isolated from Jan 2007 to Dec 2009,including 1280 strains of E.coli,485 strains of P.aeruginosa,385 strains of K.pneumoniae,and 202 strains of A.baumannii,the detection rates were 51.5%,19.4%,15.4%,and 8.0%,respectively,there were 153 strains of other gram-negative bacilli detected as well;E.coli and K.pneumoniae had the low drug resistance to amikacin,amoxicillin/clavulanate,cefoperazone/sulbactam,and imipenem,but had the high drug resistance to amoxicillin and sulfamethoxazole/trimethoprim;P.aeruginosa had the low drug resistance to cefoperazone/sulbactam,imipenem,and cefepime,but had the high resistance to ticarcillin and sulfamethoxazole/trimethoprim;A.baumannii had the low resistance to cefoperazone/sulbactam;the detection rates of ESBLs-producing E.coli and K.pneumoniae were 52.3% and 32.9%,respectively.CONCLUSION To strengthen the surveillance of antimicrobial resistance of pathogens can help the clinical doctors to use antimicrobial agents reasonably and improve the effect of treatment.