831株阴沟肠杆菌的耐药性分析

Drug resistance of 831strains of Enterobacter cloacae

目的了解医院感染阴沟肠杆菌分布特点和变迁趋势,为临床合理使用抗菌药物提供参考。方法对2005-2011年分离的阴沟肠杆菌分布及耐药率分别进行统计。结果 7年非重复分离阴沟肠杆菌831株,占所有住院非重复分离革兰阴性杆菌的5.2%,且分离率波动不大;主要分离于痰、尿、分泌物、血标本,分别占60.8%、7.8%、6.1%和5.5%;科室分布以ICU和内科为主,占36.6%和41.7%;阴沟肠杆菌的耐药率总体较低,耐药特点是2005-2008年呈上升趋势,2008年后逐年下降;ICU整体耐药水平偏高;阴沟肠杆菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢吡肟、阿米卡星和碳青霉烯类耐药率分别为11.3%、10.7%、10.0%、4.8%和0.2%,可作为经验用药首选;头孢他啶和头孢曲松耐药率分别为31.9%和30.2%,氨曲南平均耐药率为33.7%,可合理选择使用;左氧氟沙星耐药率呈下降态势,2005年为25.8%,而2010年仅4.3%,2011年升至8.4%,需有指征地选用喹诺酮类抗菌药物。结论加强医院感染细菌学监测和动态分析,对制定有效感染控制措施、杜绝感染暴发流行具有积极意义。

OBJECTIVE To investigate the distribution of Enterobacter cloacae and the changes of drug resistance so as to provide the basis for reasonable clinical use of antibiotics. METHODS From Jan. 2005 to Dec. 2011, the distribution and drug resistance rates of the clinical isolates of Enterobacter cloacae were statistically analyzed. RESULTS A total of 831 strains of non-repetitive Enterobacter cloacae were isolated during the 7 years, accounting for 5.2% among the non-repetitive gram-negative bacilli, of which the isolation rate was stable. The sputum, u- rine, secretions, and blood were the main specimens sources, accounting for 60.8% 7.8% , 6.1%, and 5.5%, respectively. The ICU and the department of internal medicine were the main departments from which the strains were isolated, accounting for 36.6% and 41.7% ,respectively. The drug susceptibility testing result showed that the drug resistance rates were stably low,keeping an upward trend from 2005 to 2008, the decreasing from 2008, the drug resistance rates of the E. cloacae strains to cefperazone-sulbactam, p iperacillin-tazobactam, cefepime, amikacin, and carbapenems were 11.3%, 10.7%, 10.0%, 4.8%, and 0.2%, respectively, and the drug resist- ance rates to ceftazidime and cefotaxime were 31.9% and 30.2%, respectively, the drug resistance to aztreonam was 33.7% ,the drugs mentioned above could be chosen rationally if necessary, and the drug resistance rate to levofloxacin kept a downward tendency with 25.8% in 2005, 4.3% in 2010, and 8.4% in 2011. The quinolones should be used indicatively. CONCLUSION It is of great significance in formulating effective infection prevention measures and preventing the infections to strengthen the bacteriological monitoring and dynamic analysis of noso- comial infections.