常见革兰阴性杆菌的耐药性分析

Drug resistance of common gram-negative bacilii

目的分析医院2011年临床分离革兰阴性杆菌的耐药性及超广谱β-内酰胺酶(ESBLs)菌株的检出率。方法采用纸片扩散法进行药敏试验,按NCCLS 2004年标准判读结果,用双相纸片法进行产ESBLs菌株确证。结果从各种标本分离到3390株革兰阴性杆菌,检出340株产ESBLs菌株,检出率为10.0%,其中大肠埃希菌218株、肺炎克雷伯菌122株,分别占64.1%、35.9%;大肠埃希菌、阴沟肠杆菌对美罗培南、亚胺培南的敏感率均为100.0%,阴沟肠杆菌对阿米卡星耐药率最低,为29.7%,对其他抗菌药物耐药率均>40.0%;鲍氏不动杆菌对头孢哌酮、氨曲南耐药率较高,分别为88.5%、78.5%,对亚胺培南、美罗培南、头孢西丁耐药率较低,分别为23.8%、24.2%、26.2%;铜绿假单胞菌对美罗培南、亚胺培南、阿米卡星敏感率较高,分别为69.0%、69.0%、73.3%。结论革兰阴性杆菌耐药性呈上升趋势,特别是对头孢菌素类耐药显著,碳青霉烯类仍是目前对革兰阴性杆菌最有效的药物;产ESBLs菌株以大肠埃希菌多见;铜绿假单胞菌的耐药率逐渐升高,应引起注意。

OBJECTIVE To evaluate the nosocomial drug resistance of the common gram-negative bacilli and the detection rate of extended spectrum β-lactamase （ESBL）-producing strains in 2011. METHODS Drug susceptibility testing was performed with K-B method, the results were analyzed by NCCLS 2004. The ESBL-producing strains were all confirmed by ceftazidime/clavulanic and cefotaxime/clavulanic with diffusion method. RESULTS Among 3390 strains of gram-negative bacilli, there were 340 of ESBLs-producing strains with the detection rate of 10.0% including Escherlchia coli （218,62.3 %） and Klebsiella pneumoniae （122,47. 1% ）. The results showed that the drug susceptibility rates of E. coli and Enterobacter cloacae to meropenem and imipenem were 100.0%, the drug resistance rate of E. cloacae was the lowest （29. 7%）, and the drug resistance rates to other antibiotics were above 40.0%; the drug resistance rates of Acinetobacter baumannii to cefoperazone and aztreonam were 88.50% and 78.5%, the drug resistance rates to imipenem, meropenem, and eefoxitin were 23.8%, 24.2%, and 26.2%, respectively; the drug susceptibility rates of Pseudomonas aeruginosa to meropenem, imipenem, and amikacin were 69.0%, 69.0%, and 73.3%, respectively. CONCLUSION The drug resistance of the gram-negative bacilli presents an upward trend, especially the drug resistance to cephalosporins, carbapenems remain as the most effective drugs against gram-negative bacilli; E. coli is the most common species of ESBLs-producing strains; the drug resistance rate of P. aeruginosa is increasing, which should be attached great importance.