医院常见革兰阴性杆菌的分布及耐药性动态监测

Dynamic monitoring of distribution and antibiotic resistance of common gram-negative bacilli

目的动态监测2010年各季度医院住院患者感染常见革兰阴性杆菌的种类、分布及耐药性,指导临床合理应用抗菌药物。方法采用MicroScanAutoScan-40半自动微生物鉴定仪和药敏系统及配套进行菌株鉴定与药物敏感性测定,并检测超广谱β-内酰胺酶(ESBLs),用WHONET5软件及SPSS12.0进行数据统计分析。结果 3136株革兰阴性杆菌临床分离菌中,主要为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌、阴沟肠杆菌和嗜麦芽寡养单胞菌;大肠埃希菌产超广谱β-内酰胺酶检出率在33.2%～62.9%,产ESBLs的肺炎克雷伯菌检出率在22.8%～43.8%;大肠埃希菌对常用的喹诺酮类、头孢类及氨曲南耐药性较高,对哌拉西林/他唑巴坦、阿米卡星、亚胺培南耐药率均<10.0%;肺炎克雷伯菌在各季度耐药性相比基本持平,对大多数抗菌药物耐药率>30.0%,保持有较强抗菌活性的抗菌药物有亚胺培南、左氧氟沙星、阿米卡星、氨苄西林/舒巴坦等抗菌药物;铜绿假单胞菌对氨基糖苷类、喹诺酮类、头孢吡肟、头孢他啶、亚胺培南、哌拉西林、哌拉西林/他唑巴坦保持较强的抗菌活性,铜绿假单胞菌对亚胺培南的耐药率有升高趋势,第三季度曾达14.0%;鲍氏不动杆菌耐药率<10.0%的只有亚胺培南,对其他抗菌药物,包括三、四代头孢菌素、氟喹诺酮类等耐药率均>40.0%,已连续出现耐亚胺培南鲍氏不动杆菌。结论临床分离的革兰阴性菌日益增多,对常用抗菌药物的耐药性增高,应重视耐药菌株的动态监测和药敏试验,根据药敏合理选择应用抗菌药物,以减少耐药菌的产生。

OBJECTIVE To dynamically monitor the antibiotic resistance and distribution of gram-negative bacilli in each quarter of 2010so as to guide the reasonable use of antibiotics.METHODS The bacterial identification and antibiotic susceptibility testing were carried out by using MicroScanAutoScan-40system,and the ESBLs were detected;the data were analyzed by WHONET 5.and SPSS12.0software.RESULTS The 3136strains of gramnegative bacilli mainly included Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,Enterobacter cloacae and Stenotrotrophomonas maltophilia.The detection rate of the extended spectrumβ-lactamases（ESBLs）-producing E.coli varied between 33.2% and 62.9%,and detection rate of ESBLs-producing K.pneumoniae varied between 22.8%and 43.8%.The E.coli strains were highly resistant to quinolones,cephalosporins and aztreonam,and the drug resistance rates to piperacillin/tazobactam,amikacin,and imipenem were less than 10.0%;the drug resistance of K.pneumoniae was basically the same in each quarter,the drug resistance rate to most of antibiotics was more than 30.0%,and imipenem,levofloxacin,amikacin and ampicillin/sulbactam maintained high antibacterial activity against the K.pneumoniae.The P.aeruginosa maintained high antibacterial activity against aminoglycosides,quinolones,cefepime,ceftazidime,imipenem,piperacillin,piperacillin/tazobactam,the drug resistance rate to imipenem kept an upward trend,reaching 14.0%in the third quarter.The drug resistance rate of the A.baumannii to imipenem was less than 10.0%,while the drug resistance rates to the third and fourth generation of cephalosporins and the fluoroquinolones were more than 40.0%,and the imipenem-resistant A.baumannii strains have emerged.CONCLUSIONThe clinical isolates of the gram-negative bacteria are increasing growing and are highly resistant to the commonly used antibiotics;it should attach great importance to the dynamic monitoring and the drug susceptibility testing and reasonably use antibiotics based on the drug susceptibility so as to reduce the drug resistant strains.