2004-2011年医院急诊科感染革兰阴性杆菌的分布及耐药性分析

Distribution and drug resistance of gram-negative bacilli causing nosocomial infections isolated from department of emergency during 2004 to 2011

目的分析复旦大学附属华山医院静安分院急诊科医院感染革兰阴性杆菌的构成比及耐药性现状,为临床抗感染治疗提供依据。方法回顾性分析2004年1月—2011年12月我院急诊科临床分离的453株革兰阴性杆菌,采用K-B纸片琼脂扩散法进行药物敏感试验,结果判定参照CLSI 2009年版标准。结果急诊科分离率最高的医院感染革兰阴性杆菌依次为大肠埃希菌(20.09%)、肺炎克雷伯菌(19.87%)、铜绿假单胞菌(17.66%)和鲍氏不动杆菌(13.69%)。453株革兰阴性杆菌对常用抗菌药物均表现出不同程度的耐药性,耐药率较低的是头孢哌酮/舒巴坦、亚胺培南和美罗培南。大肠埃希菌对亚胺培南、美罗培南和头孢哌酮/舒巴坦的耐药率分别为1.1%、1.1%和6.6%。非发酵菌中铜绿假单胞菌对亚胺培南、美罗培南和头孢哌酮/舒巴坦的耐药率分别为13.8%、22.5%和12.5%,鲍氏不动杆菌对亚胺培南、美罗培南和头孢哌酮/舒巴坦的耐药率分别为32.3%、37.1%和9.7%。结论医院革兰阴性杆菌的耐药性严重,加强细菌耐药性的监测与控制,对控制感染非常重要。

Objective To analyse the distribution and drug resistance of gram-negative bacilli causing nosocomial infections isolated from emergency department of Huashan Hospital and to provide the reference for the clinical treatment of infectious diseases. Methods Total of 453 isolates of gram-negative bacilli were obtained from clinical patients from 2004 to 2011 in emergency department. The antibiotic susceptibility test was performed by Kirby-Bauer method and the results were read based on 2009 Clinical and Laboratory Standards Institute （CLSI）. Results The most common pathogens were Escherichia coli （20.09%）, Klebsiella pneumonia （19.87%）, Pseudomonas aeruginosa （17.66%） and Acinetobacter baumannii （13.69%）. Total of 453 isolates of gram-negative bacilli exhibited a variety of resistance to commonly used antibiotics. The resistant rates of imipenem, meropenem and cefoperazone/sulbactam were lower. However, Escherichia coli resistant to imipenem, meropenem and cefoperazone/sulbactam were 1.1%, 1.1% and 6.6% respectively. Pseudomonas aeruginosa resistant to imipenem, meropenem and cefoperazone/sulbactam were 13.8%, 22.5% and 12.5% respectively. Acinetobacter baumannii resistant to imipenem, meropenem and cefoperazone/sulbactam were 32.3%, 37.1% and 9.7% respectively. Conclusion The drug resistance of gram-negative bacilli causing nosocomial infections has been serious. Strengthening monitor and control of drug resistance is extremely important for infection control.