常见两种革兰阴性杆菌的分布及耐药性分析

Analysis of The Distribution and Resistance of Two Gram-Negative Bacillus in Hospital

目的:分析我院院内常见两种革兰阴性杆菌大肠埃希菌、肺炎克雷伯菌的分布状况及其耐药特点,为临床细菌感染分析和合理使用抗生素提供依据。方法:对2007年12月~2008年9月我院门诊及住院患者标本,严格按操作规程采集、接种、培养、分离细菌并以ATB微生物鉴定系统鉴定到种,和ATB微生物药敏系统进行药敏试验并进行初筛试验。按照NC-CLS(2006)推荐的ESBLs确证试验对大肠埃希菌和肺炎克雷伯菌进行ESBLs确证检测。WHONET 5.4软件进行数据分析,耐药率的比较采用χ2检验。结果:共分离出416株革兰阴性杆菌,其中:大肠埃希菌291株,肺炎克雷伯菌125株,以呼吸内科和泌尿科感染多见。大肠埃希菌对头孢噻吩、头孢噻肟、头孢呋新、头孢西丁、头孢他啶和头孢吡肟的耐药率分别为61.8%、56.7%、59.1%、19.2%、12.4%和34.4%,肺炎克雷伯菌对头孢噻吩、头孢噻肟、头孢呋新、头孢西丁、头孢他啶和头孢吡肟的耐药率分别为63.2%、36.8%、60.8%、36.8%、25.6%、12%和15.2%。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶株检出率分别是为55.3%和54.4%,对哌拉西林、替卡西林、头孢噻肟、头孢吡肟、头孢呋新、阿米卡星、庆大霉素的耐药率显著高于非产酶株(P【0.01)。结论:大肠埃希菌和肺炎克雷伯菌的ESBLs检出率较高,分别为55.3%和54.4%。大肠埃希菌和肺炎克雷伯菌是产ESBLs的主要菌株,产ESBLs菌株的耐药性明显高于非产ESBLs菌株。治疗产ESBLs菌引起的感染最好选择亚胺培南和美罗培南,不宜选择青霉素类、头孢菌素类抗生素及氨曲南。

Objective In order to provide the basis to guide the use of antibiotics and experience medication in clinical,we analysised the resistance characteristics and distribution of the current two common Gram-negative bacteria Escherichia coli and K.peumoniae in hospital.Methods The samples of inpatients and outpatients of this hospital of Changsha form the year 2007 to 2008.The samples were collected,cultivated and isolated following the rules strictly for the operation rules strictly.The Gram-Negative Bacillus in the samples were indentified to specie by ATB system,then the antimicrobial susceptibility test was done by antimicrobial susceptibility testing system.The ESBLs producing stains were detected by ESBL screen test and confirme test recommended by NCCLS in 2006.Date analysis was done by WHONET 5.4 softeware and rate comparation was compute with χ2-test.Results A total of 416 strains of the two species were isolated,including 291 strains of E.coli and 125 strains of k.peumoniae.Most of them were isolated from respiratory department and urological department.The resistence rate of E.coli of cefalotine cefotaxime cefuroxime cefoxitine ceftazidime and cefepime was 61.8、56.7%、59.1%、19.2%、12.4% and 34.4%.The resistence rate of K.pneumoniae of cefalotine cefotaxime cefuroxime cefoxitine ceftazidime and cefepime was 63.2%、36.8%、60.8%、36.8%、25.6%、12% and 15.2%.The ESBLs producing rate of E.coli and K.pneumonia was 55.3% and 54.4%. The resistance rate to antibiotics of Piperacillin,Cefotaxime,Cefepime,Gentamycin,Amikacin of ESBLs producing strains were significant higher than that of non ESBLs producing strains(P<0.01).Conclution A high rate of ESBLs producing stains was detected,including 54.4% of E.coli and 55.4% of K.pneumonia.The E.coli and K.pneumonia were the mainly ESBLs producing microorganisms.The resisitance rate to antibiotics of ESBLs producing strains were significant higher than that of non ESBLs producing stains.In treating infections caused by ESBLs producing strains,you would better not to choose Penicillins、Cephalosporins and Aztreonam,Imipenem may be the first choice.