常见革兰阴性菌流行情况及耐药分析

Analysis of epidemic situation and drug resistance of common gram-negative bacteria

目的：了解我院住院患者分离的革兰阴性菌分布、耐药情况，为临床合理用药提供依据。方法：回顾性分析我院2013—2014年临床分离的革兰阴性菌，进行鉴定和药敏试验，分析其耐药率及耐药变化。结果：2013—2014年期间共分离细菌2030株，其中革兰阴性菌占74．7％，革兰阳性菌占25．3％。革兰阴性菌主要分离株依次为大肠埃希菌514株、铜绿假单胞菌364株、肺炎克雷伯菌240株、鲍曼不动杆菌210株，其他阴性菌250株。肠杆菌科细菌产ESBLs的检出率分别为大肠埃希菌65％，肺炎克雷伯菌36％；铜绿假单胞菌对常见抗菌药物的耐药率多在30％以下，但对亚胺培南、关洛培南的耐药率均在30％以上；鲍曼不动杆菌对多种常用抗菌药物高度耐药，耐药率多在50％以上，有些甚至超过了90％。结论：革兰阴性杆菌在我院的流行情况非常严重，需加强抗感染管理及院内流行株得监测。并根据药敏试验结果结合临床合理用药，减少滥用抗生素带来细菌耐药率的升高。

Objective ： To analyze the distribution and the drug resistance of gram-negative bacteria isolated in inpatient in our hospital for guiding rational drug use. Methods ： Retrospective analysis of the gram-negative bacteria isolated during 2013-2014 in our hospital ,perform identification and drug sensitive test to analyze the drug resistance rates and changing tendency.Results ： Totally 2030 bacterial strains were isolated during the period of 2013-2014 , 74.7% of which were gram-negative bacteria and 25.3% were gram-positive bacteria.The main gram-negative bacteria isolated were Escherichia coli （ 514 strains ） , Pseudomonas aeruginosa （ 364 strains ）, Klebsiella pneumoniae （ 240 strains ）, Acinetobacter baumannii （ 210 strains ） and other gram-negative bacteria （250 strains）.The detection rates of ESBLs in Escherichia coli and KlebsieUa pneumoniae were 65% and 36% respectively. The drug resistance rates ofPseudomonas aeruginosa to most common antibiotics were under 30%. Both lmipenem and Meropenem were above 30%; Acinetobacter baumannii is highly resistant to many kinds of common antibiotics, which resistance rates were more than 50%, some even more than 90%. Conclusions ： The prevalence of gram-negative bacteria in our hospital is very serious.The findings suggest that it is urgent to practice stringent management system for antibiotic use and close supervision over gram-negative bacteria, and infection control inventions shall be on rational basis of drug sensitivity test.