重症监护病室阴沟肠杆菌的分布及耐药性分析

Distribution and antimicrobial resistance of Enterobacter cloacae in ICU

目的了解哈尔滨医科大学附属第一医院重症监护病室临床分离阴沟肠杆菌的分布和耐药率的变迁，以指导临床合理用药。方法对2009～2012年分离的141株阴沟肠杆菌，采用Vitek-2Compact进行细菌鉴定和药敏试验。结果被检测的141株阴沟肠杆菌标本种类主要为血液（38．3％），其次为痰（26．2％）和尿液（17．0％）。药敏试验结果显示阴沟肠杆菌对氨苄西林和头孢唑林的耐药率最高〉85％。第三代头孢菌素类抗菌药物耐药率在50％-70％，氨基糖苷类和喹诺酮类抗菌药物耐药率多在60％以内，头孢吡肟及碳青霉烯类抗菌药物耐药率均〈30％。结论重症监护病室阴沟肠杆菌的耐药情况严重。头孢吡肟及碳青霉烯类抗菌药物敏感性较好，临床可作为经验用药治疗该菌引起的感染。

Objective To investigate the distribution and antimicrobial resistance of Enterobacter cloacae in ICU and provide theroretical basis of rational usage of antibiotics for the clinic. Methods A total of 141 strains of Enterobacter cloacae were collected in ICU from 2009 to 2012. Identification and antimicrobial susceptibility test of isolates were performed using a Vitek-2 Compact automtic system. Results The most strains were isolated from blood （38.3%）, then sputum （ 26.2% ） and urine （ 17.0% ）. Antimicrobial suseeptibility test showed that the resistant rates to ampicillin and eefazolin were the highest, over85%. The rates to the third generation cephalosporins were 50% ~ 70%, the rates to aminoglycoside and fluo- roquinolone antibiotics were below 60% , and the rates to cefepime and carbapenems were below 30%. Conclusion The antimicrobial resistance of Enterobacter cloacae is serious in ICU. Cefepime and carbapenems are susceptible to it and can be used to treat infections caused by Enterobacter cloacae.