常见革兰阴性杆菌3年耐药性监测

Surveillance on antimicrobial resistance of commonly Gram-negative bacilli during three years

目的了解我院2008—2010年常见革兰阴性杆菌分布情况及对各种常用抗菌药物的耐药性。方法采用纸片扩散法进行抗菌药物敏感实验,根据CLSI采用WHONET5.4软件进行数据分析。结果 3年分离革兰阴性菌共3789株,占77.1%,居前5位的为大肠埃希菌(873,23%),鲍曼不动杆菌(854,22.5%)、铜绿假单胞菌(657,17.3%)、克雷伯菌属(605,16%)及肠杆菌属(268,7%)。主要来源于痰液、分泌物、尿液及血液、脓液、胆汁等。大肠埃希菌、肺炎克雷伯菌对碳青霉烯类耐药率小于10%,2008年鲍曼不动杆菌对碳青霉烯类抗生素的耐药率为35%,2010年升高至68%,2008年对头孢哌酮/舒巴坦的敏感率为64%,2010年降至23.3%,铜绿假单胞菌对米诺环素、磺胺甲噁唑-甲氧苄啶的耐药率高于85.9%。结论医院感染以革兰阴性杆菌为主,临床应根据药敏结果合理使用抗菌药物。

Objective To investigate the distribution and antimicrobial resistance of commonly Gramnegative bacilli from the first affiliated hospital of Chongqing Medical University during 2008 to 2010. Methods Disk diffusion method was used to determine the antimicrobial susceptibility. And the WHONET 5.4 software was used to analyze the data based on the CLSI. Results From 2008 to 2010, a total of 3789 Gram-negative bacilli were isolated, accounting for 77.1% （3789/4916） during the 3 years, among which there were 873, 854, 657, 605, 268 strains of Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae were isolated, respectively. They were mainly isolated from sputum, secretions, urine and blood, pus, bile, etc. The resistance rate of E.coli and Klebsiella spp to carbapenems was the lowest （〈 10%）. The resistance rate ofA. baumannii to carbapenems was 35% in 2008, which increased to 68% in 2010. The susceptibility rate of A. baumannii to cefoperazone/sulbactam was 64% in 2008, which dropped to 23.3% in 2010. The resistance rate of P aeruginosa to minocycline and sulfamethoxazole-trimethoprim was higher than 85.9%. Conclusion The main hospital infections are Gram-negative bacilli, the selection of antibiotics should base on the drug susceptibility results.