医院感染主要致病革兰阴性杆菌分布及耐药性分析

Distribution and drug resistance of Gram-negative bacilli in nosocomial infection

目的了解医院感染主要致病革兰阴性杆菌分布及耐药性,指导临床合理用药。方法对标本采用常规方法进行细菌培养,采用美国BD公司生产的Phione100全自动细菌鉴定仪及配套的生化反应药敏板进行菌株鉴定,药敏试验方法采用最小抑菌浓度法。结果2008—2017年共分离致病革兰阴性杆菌25 455株,排在前5位依次是大肠埃希菌6 964株(27.4%)、肺炎克雷伯菌4 118株(16.2%)、鲍曼不动杆菌3 741株(14.7%)、铜绿假单胞菌3 552株(14.0%)、流感嗜血杆菌1 206株(4.7%)。标本分离以痰及咽试子标本为主,检出14 279株(56.1%),其次为尿液4 269株(16.8%)。大肠埃希菌对美罗培南(4.2%)、阿米卡星(9.3%)、哌拉西林/他唑巴坦(14.1%)、亚胺培南(17.1%)耐药率较低,肺炎克雷伯菌对美罗培南(28.3%)、亚胺培南(36.8%)耐药率比大肠埃希菌高。铜绿假单胞菌、鲍曼不动杆菌对多黏菌素B耐药率较低,耐药率分别是0.2%和0.9%,鲍曼不动杆菌对其余常用抗菌药物耐药率高,均>60%。结论革兰阴性杆菌在医院感染中分离率较高,且不同细菌的耐药性有差异,临床医师在治疗其引起的感染时应按照药敏试验结果,合理使用抗菌药物,减少细菌耐药菌株的产生。

Objective To observe the distribution and drug resistance of Gram-negative bacilli causing nosocomial infection and to guide rational drug use in clinical practice.Methods Pathogens of nosocomial infection were cultivated through conventional approach and identified using the Phione 100 automatic bacteria identification instrument and the matching biochemical reaction drug susceptibility plate produced by the American BD company for specimens.The minimum inhibitory concentration assay was used for drug susceptibility test.Results In 2008 to 2017,a total number of 25 455 strains of Gram-negative bacilli were isolated,among which there were 6 964 Escherichia coli(27.4%),4 118 Klebsiella pneumoniae(16.2%),3 741 Acinetobacter baumannii(14.7%),3 552 Pseudomonas aeruginosa(14.0%)and 1 206 Haemophilus influenzae(4.7%).The main sources of specimens were sputum and pharyngeal specimen(14 279 strains,56.1%),and urine(4 269 strains,16.8%).Escherichia coli showed low resistances to meropenem(4.2%),amikacin(9.3%),piperacillin/tazobactam(14.1%)and imipenem(17.1%).Klebsiella pneumoniae showed higher resistance rates to meropenem(28.3%)and imipenem(36.8%)compared with those of Escherichia coli.Pseudomonas aeruginosa and Acinetobacter baumannii showed low resistance rates to polymyxin B,which were 0.2%and 0.9%.Acinetobacter baumannii showed high resistance to commonly used antibiotics(>60%).Conclusions Gram-negative bacilli represent a high isolation rate in patients with nosocomial infection and there are certain differences in major bacteria resistant to common antibacterial agents.Rational antibiotics should be used according to drug susceptibility test results to help the effective control of infection and avoid the production of drug-resistant strains.