无菌部位常见革兰阴性菌的分布特点与耐药性分析

Distribution and antimicrobial resistance analysis of gram-negative bacteria in sterile sites

目的：了解浙江省人民医院无菌部位样本常见革兰阴性菌的分布特点和耐药情况。方法回顾性分析2008—2012年浙江省人民医院无菌部位样本连续分离获得的革兰阴性菌对临床常用抗菌药物的体外药敏试验结果，并用WHONET-5软件分析数据。结果共分离到2018株革兰阴性菌，前5位病原菌分别为大肠埃希菌（586株，29.0%）、肺炎克雷伯菌（413株，20.5%）、鲍曼不动杆菌（300株，14.9%）、铜绿假单胞菌（192株，9.5%）和阴沟肠杆菌（92株，4.6%）。体外药敏试验结果显示，肠杆菌科细菌对阿米卡星（12.9%）、美罗培南（14.1%）、亚胺培南（16.8%）、厄他培南（17.5%）和替加环素（0～9.1%）的耐药性较低。其中大肠埃希菌对厄他培南、替加环素、阿米卡星、阿莫西林/克拉维酸、美罗培南、头孢替坦、头孢西丁、头孢哌酮/舒巴坦、亚胺培南、呋喃妥因和哌拉西林/他唑巴坦的耐药率低，均低于15%；肺炎克雷伯菌的耐药问题较突出，除对阿莫西林/克拉维酸耐药率低，对其他含酶抑制剂的复合制剂喹诺酮类的耐药率均〉40%。大肠埃希菌和肺炎克雷伯菌中产超广谱β内酰胺酶菌株分别占54.8%和25.1%。非发酵菌中，鲍曼不动杆菌对多黏菌素B（0）和替加环素（15.4%）的耐药性较低，铜绿假单胞菌对阿米卡星（9.2%）、妥布霉素（10.9%）和庆大霉素（19.0%）的耐药性较低。结论革兰阴性菌的耐药问题突出，尤其是肺炎克雷伯菌和非发酵菌，应加强监测其耐药变化趋势以指导临床合理用药。

Objective To investigate the clinical distribution and antimicrobial resistance of the gram-negative bacteria in sterile sites from Zhejiang Provincial People＇s Hospital. Methods The antimicrobial susceptibility test against common clinical antibacterial drugs in vitro for gram-negative bacteria in sterile sites of Zhejiang Provincial People＇s Hospital from 2008 to 2012 were analyzed retrospectively, and the data were analyzed by WHONET-5 software. Results A total of 2 018 isolates were collected. The top 5 most common pathogens were Escherichia coli （586 strains, 29.0% ）, Klebsiella pneumoniae （413 strains, 20.5% ）, Acinetobacter baumannii （300 strains, 14.9%）, Pseudomonas aeruginosa （192 strains, 9.5%） and Enterobacter cloacae （92 strains, 4.6%）. The antimicrobial susceptibility test result showed low resistance rates of antibacterial agents for Enterobacteriaceae were amikacin （12.9%）, meropenem （14.1%）, imipenem （16.8%）, ertapenem （17.5%） and tigecycline （0-9.1%）. Escherichia coli showed low drug resistance rates to ertapenem, tigecycline, amikacin, amoxicillin/clavulanic acid, meropenem, cefotetan, cefoxitin, cefoperazone/sulbactam, imipenem, nitrofurantoin and piperacillin/tazobactam, which were all under 15%. The resistance of Klebsiella pneumoniae was a prominent problem, except for amoxicillin-clavulanic acid, the resistant rates to other complex preparation containing enzyme inhibitors and quinolones were all higher than 40%. The extended-spectrum β-lactamase strainsof Escherichia coli and Klebsiella pneumonia accounted for 54.8% and 25.1%. Among non-fermentative bacteria, Acinetobacter baumannii showed low drug resistance to polymyxin B （0） and tigecycline （15.4%）, and the drug resistance rates of Pseudomonas aeruginosa to amikacin （9.2%）, tobramycin（10.9%） and gentamicin （19.0%） were low. Conclusions Antimicrobial resistance of the gram-negative bacteria is a serious problem, especially in Klebsiella pneumoniae and non-fermentative bacteria. The surveillance of antimicrobial resistance for the rational use of antibacterial agent should be further strengthened.