2009年10月-2012年6月我院ICU患者感染革兰阴性杆菌分布及产酶、耐药相关性分析

Relationship of Drug Resistance with Enzyme-producing and Distribution of Gram-negative Bacilli of Patients in Intensive Care Unit of Our Hospital during Oct. 2009-Jun. 2012

目的:了解重症监护病房(ICU)患者感染革兰阴性杆菌分布及产酶、耐药情况,指导临床合理用药。方法:对2009年10月-2012年6月我院ICU送检的临床标本进行培养、分离、鉴定,采用手工法及法国生物梅里埃全自动细菌鉴定系统对菌种进行鉴定,采用K-B琼脂扩散法进行药敏试验,采用改良三维试验对细菌超广谱β-内酰胺酶(ESBLs)、Amp C酶进行检测,根据美国临床实验室标准化协会(CLSI)2008年标准进行判读。结果:送检的临床标本中分离出194株革兰阴性杆菌,其中鲍曼不动杆菌41株、铜绿假单胞菌48株、阴沟肠杆菌29株、肺炎克雷伯菌24株、大肠埃希菌16株、枸橼酸杆菌属12株、嗜麦芽窄食单胞菌11株、粘质沙雷菌7株、产气肠杆菌6株。194株革兰阴性杆菌中共检出单产ESBLs菌株59株(30.4%),单产Amp C酶菌株57株(29.4%),同时产ESBLs和AmpC酶菌株11株(5.7%)。所有病原菌对抗菌药物均有不同程度的耐药,对亚胺培南/西司他丁、阿米卡星的敏感性高,产酶菌株的耐药率高于不产酶菌株。讨论:ICU患者革兰阴性杆菌耐药性呈上升趋势,对亚胺培南/西司他丁、阿米卡星敏感性高;应根据药敏试验结果选择抗菌药物,以减少耐药菌株的产生。

OBJECTIVE： To investigate the distribution of Gram-negative bacilli, drug resistance and enzyme producing in intensive care unit （ICU）, and to provide guidance for rational use of drugs in the clinic. METHODS： Clinical specimens isolated from ICU of our hospital were cultured and identified by manal method and Biomerieux identification system during Oct. 2009- Jun. 2012. The drug-susceptibility was detected by K-B agar diffusion method. Modified three-dimensional method was used to detect extended-spectrtma fl-lactamases （ESBLs） and AmpC enzyme, which was interpreted by the standards of United States CLSI （2008 edition）. RESULTS： A total of 194 Gram-negative bacilli strains were collected, among which there were 41 strains of Aci- netobacter baumannii, 48 strains of Pseudomonas aeruginosa, 29 strains of Enterobacter cloacas, 24 strains of Klebsiella pneumoniae, 16 strains of Escherichia coli, 12 strains of Citrobacter species, 11 strains of Stenotrophomonas maltophilia, 7 strains of Chromobacterium prodigiosum, 6 strains of Enterobacter aerogenes. Among 194 strains of Gram-negative bacilli, there were 59 strains producing ESBLs （30.4 % ）, 57 strains producing AmpC enzyme （29.4 % ）, 11 strains producing ESBLs and AmpC enzyme （5.7 % ）. All Gram-negative bacilli were resistant to commonly used antibiotics in different degree. They were sensitive to imipenerrd cilastatin and amikacin, and the resistance rate of the strains producing enzyme were obviously greater than that of the strains not producing enzyme. CONCLUSIONS： Drug resistance of Gram-negative bacilli in senile patients keeps an upward tendency in ICU, and the susceptibility to imipenem/cilastatin and amikacin is in high level. The antibiotic should be selected according to the results of drug sensitivity test so as to reduce the drug-resistant strains.