2014年我院常见革兰阴性菌的耐药性分析

Drug Resistance Analysis of Gram-negative Bacteria in Our Hospital in 2014

目的：了解我院2014年4-12月革兰阴性菌的分离率及耐药性,以促进我院革兰阴性菌感染的预防和治疗,为临床合理使用抗菌药物提供依据。方法：对我院2014年4-12月微生物检验科分离的菌株进行药敏试验,采用迪尔公司生产的DL-96Ⅱ半自动细菌测定系统及药敏分析仪进行细菌鉴定和药敏试验,统计分析细菌培养及体外药敏试验数据。结果：共分离出731株细菌,革兰阴性菌504株（68.9%）,革兰阳性菌227株（31.1%）。检出产超广谱β-内酰胺酶（ESBLs）大肠埃希菌38株（42.2%）,ESBLs肺炎克雷伯菌18株（18.0%）。革兰阴性杆菌是临床的主要致病菌,其中肺炎克雷伯菌（100株,19.8%）,大肠埃希菌（90株,17.8%）,铜绿假单胞菌（31株,6.15%）,鲍曼不动杆菌（31株,6.15%）,阴沟肠杆菌（28株,5.56%）,占革兰阴性菌的前5位,肠杆菌科细菌对阿米卡星、亚胺培南、美罗培南、头孢吡肟、哌拉西林-他唑巴坦、头孢哌酮-舒巴坦、米诺环素的耐药率分别为1.0%~7.1%,0.0%~2.0%,0.0%~2.2%,0.0%~24.4%,2.0%~7.1%,2.0%~7.1%,6.7%~17.9%,对头孢呋辛、头孢唑林、氨苄西林、复方磺胺甲唑（除肺炎克雷伯菌）都表现为极高的耐药,耐药率大于50%,非发酵菌（铜绿假单胞菌,鲍曼不动杆菌）检出相同,其中鲍曼不动杆菌仅对米诺环素、多黏菌素B、美罗培南、头孢哌酮-舒巴坦、阿米卡星高度敏感（敏感率〉80%）,对亚胺培南和美罗培南的耐药率分别为22.6%和19.4%,对其余抗菌药物耐药情况严重,铜绿假单胞菌仅对多黏菌素B、诺氟沙星、左氧氟沙星、环丙沙星敏感性较高（敏感率〉80%）,对亚胺培南和美罗培南的耐药率分别为25.8%和22.6%,对其余抗菌药物耐药情况严重。结论：革兰阴性菌是我院感染的主要病原菌,以肠杆菌为主,耐药现象严重,临床医师应加强病原学送检率,参考药敏试验结果合理选择抗菌药物。

Objective ：To understand the isolation rate and drug resistance of Gram-negative bacteria in our hospital from April to December 2014 and to promote the prevention and treatment of gram-negative bacterial infections in our hospital, so as to provide the basis for rational use of antimicrobial agents in clinical practice. Methods ：Drug sensitivity tests of bacterial strains were conducted which were isolated by microbiological laboratory of our hospital from April to December 2014. DL-96 Ⅱ semi-automatic bacterial assay system and drug sensitive analyzer produced by Deere Company were used for bacterial identification and the analysis of the bacterial culture and drug sensitivity test data. Results：About 731 bacterial strains were isolated, 504 strains were gram-negative（68.9%）and 227 gram-positive（31.1%）. About 38 strains（42.2%） were extended spectrum of beta-lactamases（ESBLs）Escherichia coli strains, 18 strains were ESBLs Klebsiella pneumoniae（18.0%）. Gram-negative bacilli were the main pathogenic bacteria in clinic, among which the top five bacteria included Klebsiella pneumoniae（100 strains, 19.8%）,Escherichia coli（ 90 strains, 17. 8 %）, Pseudomonas aeruginosa（ 31 strains, 6. 15 %）, Acinetobacter baumannii（ 31 strains, 6.15%） and Enterobacter cloacae（ 28 strains, 5.56%）. The drug resistance rates of enterobacteriaceae to amikacin, imipenem, meropenem, cefepime, piperacillin tazobactam, cefoperazone sulbactam and minocycline were 1.0% ~7.1%, 0.0% ~2.0%, 0.0% ~2.2%, 0.0% ~24.4%, 2.0% ~7.1%, 2.0% ~7.1%, 6.7% ~17.9% respectively, and extremely high resistance rates were showed, which was greater than 50%, to cefuroxime, cefazolin,ampicillin and compound sulfamethoxazole（except Klebsiella pneumoniae）. Pseudomonas aeruginosa and Acinetobacter baumannii as the non fermentative bacteria were detected with the same results. Acinetobacter baumannii was only highly sensitive to minocycline, polymyxin B, meropenem, cefoperazone sulbactam and amikacin（the sensitive rate was greater than 80%）, its resistance rates to imipenem and meropenem were 22.6% and 19.4% and very high resistance rates to other antibacterials. Pseudomonas aeruginosa showed high sensitive to polymyxin B, norfloxacin,levofloxacin and ciprofloxacin（the sensitive rate was greater than 80%）, its resistant rates to imipenem and meropenem were 25.8% and 22.6% and very high resistance rates to other antibacterials. Conclusion ：Gram-negative bacteria are the main pathogenic bacteria for our hospital infections and the drug resistance of enterobacteriaceae is serious. Clinicians should pay more attention to the submission rate for testing of pathogens and choose suitable antibacterials according to the results of drug sensitivity test.