革兰阴性杆菌的分布及耐药性监测

Distribution of gram-negative bacilli and surveillance for antimicrobial resistance

目的了解2010年医院住院患者感染性标本中分离的革兰阴性杆菌的构成比及耐药特征,为临床选择抗菌药物提供实验室依据。方法病原菌培养及鉴定按照《全国临床检验操作规程》,采用常规方法进行;药敏试验采用CLSI推荐的K-B法。结果 683株革兰阴性杆菌中铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌占前5位,分别占38.8%、19.8%、17.4%、6.0%、4.1%;革兰阴性杆菌对常用抗菌药物大多数呈现多药耐药趋势,其中铜绿假单胞菌和鲍氏不动杆菌对亚胺培南和美罗培南的耐药率达22.6%～51.2%。结论临床医师应注重病原菌耐药性的监测,根据病原菌类型及耐药特征合理选择抗菌药物。

OBJECTIVE To understand the constituent ratio and antimicrobial resistance of gram-negative bacilli isolated from infective specimens in 2010 and offer experimental evidence for clinical use of antibiotics. METHODS Referring to National Guide to Clinical laboratory Procedures, bacterial culture and identification were performed by the routine methods. The drug susceptibility test was performed by K-B methods recommended by CLSI. RESULTS Among 683 isolates of gram-negative bacilli, the top five of isolation rates were Pseudomonas aerugino- sa （38.8%）, Escherichia coli （19. 8%）, Klebsielle peneurnoniae （17. 4%）, Acinetobacter baumanii （6. 0%）, and Stenotrophomonas maltophilia （4.1%）, against which most of the commonly used antibiotics showed multi- drug-resistant trends. The resistance rates of imipenem and meropenem against P. aeruginosa and A. baumanii varied between 22. 6% and 51.2%. CONCLUSION The clinician should attach importance to the monitoring of antimicrobial resistance and prescribe the antibiotics according to the species of the pathogens and the characteristics of antimicrobial resistance.