2010—2013年柳州市工人医院血液科革兰阴性菌的分布与耐药性分析

Clinical analysis of Gram-negative bacteria distribution and drug resistance in hematology department of Liuzhou Worker's Hospital from 2010 to 2013

目的了解广西柳州市工人医院2010—2013年血液科常见革兰阴性菌的分布及耐药趋势,以指导临床合理使用抗菌药物。方法对2010年1月—2013年12月广西柳州市工人医院血液科送检分离出的病原菌菌株及其耐药性进行回顾性调查分析。结果共分离出常见的革兰阴性菌508株,主要以大肠埃希菌和肺炎克雷伯菌为主,分别占26.2%、21.7%;铜绿假单胞菌和鲍曼不动杆菌检出率分别为16.5%、13.6%。超广谱β-内酰胺酶检测结果显示,肺炎克雷伯菌和大肠埃希菌的平均检出率分别为40.2%、60.5%。阴沟肠杆菌、肺炎克雷伯菌和大肠埃希菌对碳青霉烯类抗菌药物总体上有较高的敏感性;铜绿假单胞菌、鲍曼不动杆菌对多数抗菌药物高度耐药,且呈逐年上升趋势。结论血液科临床分离的革兰阴性菌的比例较高,对常用抗菌药物耐药严重,应加强革兰阴性杆菌耐药性的动态监测,以指导临床进行合理规范的抗感染治疗。

Objective To investigate the distribution and antimicrobial resistance of commonly Gram-negative bacteria from the hematology department of Liuzhou Worker＇s Hospital during 2010 to 2013, and to instruct the reasonable clinical application of antibiotics. Methods The clinical data and drug resistance of Gram-negative bacteria distribution isolated from the hematology department from 2010 to 2013 were reviewed retrospectively. Results All of 508 Gram-negative bacteria were isolated, the main strains were Escherichia coli （26.2%）, Klebsiella pneumoniae （21.7%）, Pseudomonas aeruginosa （16.5%）, and Acinetobacter baumannii （13.6%）. The extended spectrum β-lactamases （ESBLs） of E. coli and K. pneumoniae were 60.5% and 40.2%, respectively. The antibiotics sensibility result was analyzed, E. cloacae, K. pneumoniae, and E. coli kept high sensibility to carbapenem. P. aeruginosa and A. baumannii kept high resistance to most antibiotics and increased year by year. Conclusion The Gram-negative bacteria are the most common bacteria in hematology department and showed multi-drug resistance. We should strengthen the dynamic monitoring of drug resistance of Gram-negative bacteria, so as to instruct the clinicians to have anti-infectious remedy reasonably and normatively.