医院感染革兰阴性菌的分布与耐药性监测

Distribution of gram-negative bacteria causing nosocomial infections and surveillance of drug resistance

目的了解医院感染主要革兰阴性菌的分布及对抗菌药物的耐药性,为临床合理使用抗菌药物提供参考依据。方法回顾性分析2013年1月-2015年6月临床科室送检标本中分离出的6 928株革兰阴性菌包括:铜绿假单胞菌(PAE)、鲍氏不动杆菌(ABA)、大肠埃希菌(ECO)和肺炎克雷伯菌(KPN)非重复菌株的分布与耐药性;采用法国生物梅里埃公司全自动微生物分析仪进行细菌鉴定和药敏试验,数据采用WHONET 5.6软件进行统计分析。结果 6 928株革兰阴性菌依次为PAE、ABA、ECO、KPN,分别占34.8%、26.4%、22.3%、16.5%;PAE对阿米卡星的耐药率最低,为5.2%;ABA对头孢哌酮/舒巴坦的耐药率最低,为52.8%;产超广谱β-内酰胺酶(ESBLs)ECO和KPN检出率分别为58.5%、39.8%,产ESBLs菌株的耐药率明显高于非产ESBLs菌株。结论定期对细菌耐药性监测数据进行统计分析,有助于了解细菌耐药性变化,为临床医师合理使用抗菌药物提供实验室依据。

OBJECTIVE To investigate the distribution and drug resistance of the main gram-negative bacteria causing nosocomial infections so as to provide guidance for reasonable clinical use of antibiotics. METHODS A total of 6 928 strains of non-repetitive gram-negative bacteria were isolated from the submitted specimens that were obtained from the clinical departments from Jan 2013 to Jun 2015, involving 4 species like Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae. The bacterial identification was carried out by using the automatic microorganism analyzer of bioMerieux, France, the drug susceptibility testing was conducted, and the statistical analysis of data was performed with the use of WHONET 5.6 software. RESULTS Of 6 928 strains of gram-negative bacteria, 34.8% were P. aeruginosa, 26.4% were A. baumannii, 22.3% were E. coli, and 16. 5 % were K. pneumoniae. The drug resistance rate of the P. aeruginosa to amikacin was lowest （5.2 % ） ; the drug resistance rate of the A. baumannii to cefoperazone-sulbactam was lowest （52.8 % ）. The detection rates of the extended-spectrum β-lactamase （ESBLs）-producing E. coli and K. pneumoniae were 58.5 % and 39.8%, respectively. The drug resistance rate of the ESBLs-producing strains was significantly higher than that of the non-ESBLs-producing strains. CONCLUSION The regular statistical analysis of the surveillance data of bacterial drug resistance may contribute to the understanding of the change of the bacterial drug resistance, which can provide the laboratory basis for reasonable clinical use of antibiotics.