常见革兰阴性菌耐药性分析与合理用药研究

The durg resistance of common Gram-negative bacteria and the rational use of drugs

目的分析芜湖市第一人民医院革兰阴性病原菌分布情况及对常见抗菌药物的耐药程度,为临床抗菌药物的选择及其合理使用提供参考。方法收集2015年1月至2017年12月我院临床科室送检的细菌培养标本,采用法国生物梅里埃公司生产VITEK2compact全自动微生物分析系统及其配套试剂盒进行细菌鉴定及药敏试验,数据采用WHONET 5.6软件进行统计分析。对年度耐药株数使用R语言3.4.0软件进行分析。结果 2015-2017年我院共检出病原菌3 728株,其中革兰阳性菌1 055株,占28.3%;革兰阴性菌2 673株,占71.7%。革兰阴性菌中主要致病菌为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞杆菌、鲍曼不动杆菌,对青霉素类和第一代头孢菌素类抗菌药物高水平耐药。2017年这4种细菌对头孢唑林的耐药率均已达100.0%。鲍曼不动杆菌对头孢曲松的耐药率逐年上升,对头孢替坦连续3年耐药率均为100.0%,对氨苄西林/舒巴坦、氟喹诺酮类以及头孢吡肟耐药率未逐年上升,对亚胺培南耐药率变化显著,差异均有统计学意义(P<0.05)。铜绿假单胞杆菌对氨曲南耐药率逐年上升,对氨基糖苷类及头孢他啶耐药率逐年下降,差异均有统计学意义(P<0.05)。大肠埃希菌和肺炎克雷伯菌对头孢吡肟耐药率逐年下降,差异有统计学意义(P<0.05)。结论我院住院患者病原菌以革兰阴性菌为主,不同病原菌对药物的敏感性各异,临床医生应结合患者情况和药敏结果综合分析,合理选用抗菌药物。

Objective To analyze distribution of Gram negtive bacteria isolated in our hospital and their resistance to common antibiotics,so as to provide a basis for the rational use of drugs.Methods Bacterial culture specimens were collected from the clinical departments of our hospital from January 2015 to December 2017.Bacterial identification and drug sensitivity were performed by using full automatic microbial analysis system.The data were analyzed with WHONET 5.6 software.Annual resistant strains were subjected to Cochran Armertage Trend Test with R3.4.0 software.Results A total of 3,728 strains of bacteria were isolated,including 1,005 strains（28.3%）of Gram-positive bacteria and 2,673 strains（71.7%）of Gram-negative bacteria.The main Gram-negative pathogens were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii,which had high drug resistances to Penicillins and the first generation Cephalosporins.In 2017,the resistance rate of the four bacteria to Cefazolin had reached 100.0%.The resisitance rate of Acinetobacter baumannii to Ceftriaxone increased year by year,and that to Cefotetan was100.0%for three consecutive years,while those to Ampicillin/Sulbactam,Quinolones and cefepime did not increase,and that to imipenem changed significantly,with statistically significant difference（P〈0.05）.The resistance rate of Pseudomonas aeruginosa to Aztreonam increased while those to Aminoglycosides and Ceftazidine declined year by year,with statistically significant differences（Ps〈0.05）.The resistances of E.coli and Klebsiella pneumonia to Cefepime decreased year by year;the differences had statistical significance（P〈0.05）.Conclusion The pathogenic bacteria isolated from hospitalized patients in our hospital were mainly Gram negative bacteria.Different pathogens have different drug sensitivities.Clinicians should rationally select antibiotics based on the conditions of patients and the results of drug sensitivity test.