下呼吸道感染革兰阴性杆菌的耐药现状分析

Analysis of antibiotic resistance in nosocomial infections with gram-negative bacilli from lower reapiratory tract

目的:了解下呼吸道感染主要病原菌的分布及其耐药性,指导临床合理使用抗生素。方法:617株革兰阴性杆菌采用法国生物-梅里埃VITEK全自动微生物分析系统和GNI鉴定卡进行菌种鉴定;采用KB法进行药敏试验,按照美国临床实验室标准化研究所(CLSI)2007版操作和判断结果。结果:分离率居前位的革兰阴性杆菌依次为:铜绿假单胞菌(43%)、鲍曼不动杆菌(16%)、肺炎克雷伯菌(15%)、大肠埃希菌(8%)、嗜麦芽窄食单胞菌(8%)、肠杆菌属(4%)。以上菌株对常用抗菌药物产生了严重的耐药性。产超光谱B-内酰胺酶(ESBLs)细菌总检出率为54.1%;铜绿假单胞菌何鲍曼不动杆菌泛滥药菌株检出率分别为3.4%和6.1%。结论:下呼吸道感染革兰阴性菌多为多重耐药病原菌,应熟悉细菌耐药特点及耐药机制,根据病原学检查结果合理选用抗菌药物。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in lower respiratory tract infection,guide clinical use of antibiotic.Methods 617 strains of gram negative bacilli by French biology-bio Merieux VITEK automatic microbial analysis system and GNI identification card for identification;drug sensitivity test was performed by using KB method,according to the study of American Clinical Laboratory Standard Institute（CLSI） 2007 version and the judging results.Results The isolation rate in the former gram-negative bacilli were：Pseudomonas aeruginosa（43%）,Bauman Acinetobacter（16%）,Klebsiella pneumonia（15%）,Escherichia coli（8%）,Stenotrophomonas maltophilia（8%）,Enterobacter spp（4%）.The above strains produce serious drug resistance to commonly used antimicrobial agents.Producing extended spectnun-lactamases（B-ESBLs） bacteria detection rate was 54.1%;Pseudomonas aeruginosa and Acinetobacter strains spread Hobowmandrug detection rates were 3.4% and 6. l%.Conclusion Gram negative bacteria for multiple drug resistance of pathogens in lower respiratory tract infection,should be familiar with the characteristics of bacterial resistance and resistance mechanisms,the reasonable selection of antimicrobial agents according to the etiological examination results.