3年主要革兰阴性菌的耐药性变迁

Surveillance on antimicrobial resistance in clinical isolates of common gram negative during three years

目的：分析临床分离的常见革兰阴性菌的分布及耐药情况，为临床使用抗菌药物提供依据。方法收集2010年1月至2012年12月临床标本中检出的革兰阴性菌，分析其分布及耐药情况。结果3年间共检出革兰阴性菌8258株，前4位是大肠埃希菌（2227株，27．0％），肺炎克雷伯菌（1363株，16．5％），铜绿假单胞菌（1141株，13．8％），鲍曼不动杆菌（1078株，13．1％）。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）菌株的总检出率分别为50．6％和38．3％，大肠埃希菌和肺炎克雷伯菌对亚胺培南和美罗培南敏感率最高，值得注意的是肺炎克雷伯非ESBLs菌株对大部分三代头孢菌素类的耐药率呈逐年上升趋势。铜绿假单胞菌对氨基糖苷类抗菌药物、头孢吡肟和哌拉西林／他唑巴坦的敏感率均较高，分别为83．0％～96．4％、81．2％～82．8％和90．0％～94．7％，鲍曼不动杆菌对大多数抗菌药物的耐药率有逐年下降趋势。结论临床数据显示，细菌耐药性的变化是不可预测的，连续性监测对动态掌握抗菌药物的耐药趋势以指导抗菌治疗是必要的。

Objective To analyze the distribution and resistance of the gram-negative bacteria,and to put forward suggestions for clinical medication. Methods The retrospective analysis was conducted on distribution and drug-resistance profile of the gram- negative collected from both inpatients and outpatients in our hospital from January 2010 to December 2012. Results A total of 8 258 gram-negative strains were isolated from 2010 to 2012,the top four pathogens were Escherichia coli （2 227,27.0%） ,Klebsiel- la pneumoniae （1 363,16.5%） ,Pseudornonas aeruginosa （1 141,13.8%） ,Acinetobacter baurnannii （1 078,13. 1%）. The preva- lence of ESP, Ls producing strains was 50.6 % in Eescherichia coli and 38.3 % in Klebsiella pneurnoniae isolates on average. Esche- richia coli and Klebsiella pneumoniae had highest sensitive rate to imipenem and meropenem, particular attention was paid to the rate of non-ESBLs producing Klebsiella pneurnoniae resistant to 3rd generation cephalosporins was increased year by year. Pseudo- monas aeruginosa had relative higher resistant rate to aminoglycosides （83.0 % - 96.4 %）, cefepime （81.2 % - 82.8 %） and pip- eracillin/tazobactam （90.0%-94.7 %）. Resistance of Acinetobacter baumannii to most of antibiotics was decreased year by year. Conclusion The results show that drug-resistance of pathogens are constantly changing, and continuous monitoring distribution and drug-resistance profile of pathogens can provide evidence to clinical antibacterial therapy.