住院患者肠杆菌科细菌医院感染的耐药性分析

Clinical analysis of drug resistance of Enterobacteriaceae causing nosocomial infections in hospitalized patients

目的了解医院临床分离肠杆菌科细菌的分布及耐药性,为临床抗感染治疗提供依据。方法分析2011年3月-2012年9月临床标本分离的肠杆菌科细菌检出率、分布特点及药敏结果,分离的所有肠杆菌科细菌应用法国生物梅里埃公司VITEK-32微生物分析仪进行菌株鉴定,药物试验采用K-B法。结果共检出379株肠杆菌科细菌,大肠埃希菌174株占45.91%,肺炎克雷伯菌119株占31.40%,肠杆菌属76株,占20.05%;送检标本分别为痰液201株占53.03%,肺泡灌洗液103株占27.18%,穿刺液32株占8.44%;大肠埃希菌对氨苄西林、头孢噻肟和头孢唑林的耐药率分别为100.00%、99.43%和99.43%,对阿莫西林/克拉维酸耐药率为6.32%,大肠埃希菌对亚胺培南100.00%敏感;肺炎克雷伯菌对氨苄西林耐药率为100.00%,对头孢他啶、阿莫西林/克拉维酸的耐药率为70.59%和77.31%,而对哌拉西林/舒巴坦和亚胺培南100.00%敏感;肠杆菌属对氨苄西林、头孢唑林、阿莫西林/克拉维酸、氨苄西林/舒巴坦、头孢西丁和头孢呋辛的耐药率均>76.32%,而对头孢哌酮/舒巴坦耐药率为6.59%,对亚胺培南100.00%敏感。结论病原菌的耐药性检测对临床治疗尤为重要,常见肠杆菌科细菌对抗菌药物的耐药性有明显地上升趋势,合理使用抗菌药物是有效地预防和控制医院病原菌感染的暴发流行。

OBJECTIVE To understand the distribution and drug resistance of clinical isolates of Enterobacteriaceae so as to provide guidance for clinical treatment of infections. METHODS From Mar 2011 to Sep 2012, the detection rates , distribution, and result of drug susceptibility testing of Enterobacteriaceae isolated from clinical specimens were analyzed, then the strains were identified with the use of VITEK-32 microorganism analyzer of BioM%rieux, France, and the drug susceptibility testing was performed by using K B method. RESULTS A total of 379 strains of Enterobacteriaceae have been isolated, including 174 （45.91 % ） strains of Escherichia coli, 119 （31.40 % ） strains of Klebsiella pneumoniae, and 76 （20. 05%） strains of Enterobacter; among Enterobacteriaceae strains isolated, 53.03% （201 strains） were isolated from the submitted sputum specimens, 27.18% （103 strains） from alveolar lavage fluid, 8. 44% （32 strains ） from puncture fluid. The drug resistance rates of E. coli to ampiciilin, eefotaxime, and cefazolin were 100.00%, 99. 430/oo, and 99.43%, respectively, amoxicillin-clavulanic acid 6. 32% and the drug susceptibility rate of the E. coli to imipenem was 100.00% ; the drug resistance rate of the K. pneumaniac to ampicillin was 100.0%, the drug resistance rates to ceftazidime and amoxicillin-clavulanic acid were 70.59% and 77.31 %, respectively, however, the drug susceptibility rate to piperacillin-sulbactam and imipenem were 100. 00%; the drug resistance rates of Enterobacter to ampieillin, cefazolin, amoxicillin-clavulanic acid, ampicillin-sulbactam, eefoxitin, and cefuroxime were more than 76.32 %, the drug resistance rate to cefoperazonesulbactam was 6. 59%, and the drug susceptibility rate to imipenem was 100. 00%. CONCLUSION The drug resistance test for the pathogens is of great significance to the clinical treatment; the drug resistance rates of the common species of Enterobacteriaceae show significant upward trend; it is an effective way to reasonably use anti biotics so as to control the prevalence of nosoeomiai infections.