某医院2014-2017年耐碳青霉烯类革兰阴性杆菌分布及耐药性

The distribution and drug-resistance of Carbapene-resistant Gram-negative bacilli in a hospital from 2014 to 2017

目的了解2014-2017年玉溪市人民医院耐碳青霉烯类革兰阴性杆菌在临床标本及科室中的检出情况及耐药情况,为防治耐碳青霉烯类革兰阴性杆菌提供依据。方法采用VITEK2 COMPACT微生物分析仪对细菌进行鉴定和药敏试验。结果共检出952株耐碳青霉烯类革兰阴性杆菌,涉及17个菌属30个菌种,主要来自痰样本(669株,72.27%)、尿液(90株,9.45%)和体表分泌物(54株,5.67%)。科室分布显示重症医学科有309株(32.46%),急诊内科121株(12.71%),神经内科113株(11.87%),呼吸内科83株(8.72%)。检出细菌中鲍曼不动杆菌仅对庆大霉素和左氧氟沙星的耐药率小于40.00%;大肠埃希菌仅对阿米卡星和呋喃妥因的耐药率小于40.00%;铜绿假单胞菌对哌拉西林、头孢吡肟、氨曲南、阿米卡星、庆大霉素、左氧氟沙星和环丙沙星的耐药率低于40.00%;肺炎克雷伯菌肺炎亚种对厄他培南、阿米卡星、四环素、复方新诺明的耐药率小于40.00%。结论耐碳青霉烯类革兰阴性杆菌分布较广,不同细菌对抗菌药物的耐药状况不同。鲍曼不动杆菌和大肠埃希菌的耐药性较高,应重视监测细菌耐药情况,指导临床合理使用抗菌药物,更好地控制耐药菌株的产生及传播。

Objective To investigate the distribution and drug resistance of Carbapene-resistant Gram-negative bacilli in clinical specimens and departments of our hospital from 2014to 2017,and provide basis for the prevention and treatment of Carbapene-resistant Gram-negative bacilli.Methods The bacteria were identified and tested with VITEK2COMPACT microorganism analyzer.Results 952strains of Carbapene-resistant Gram-negative bacilli were detected,mainly involving 30species of 17genera,among which 669strains(72.27%)were from sputum samples,90strains(9.45%)from urine,and 54strains(5.67%)from somatic secretions.309strains(32.46%)were mainly from ICU,121strains(12.71%)from emergency department,113strains(11.87%)from neurology department,and 83strains(8.72%)from respiratory medicine department.The resistance rates of Acinetobacter baumannii to Gentamicin and Levofloxacin,those of E.coli to Amikacin and Furantoin,those of Pseudomonas aeruginosa to Piperacillin,Cefepime,Amitriptyline,Amikacin,Gentamicin,Levofloxacin and Ciprofloxacin,as well as those of Klebsiella pneumoniae subspecies to Etapenem,Amikacin,Tetracycline and compound Neoprene were all less than 40.00%.Conclusion The distribution of Carbapene-resistant Gram-negative bacilli is wide.Different bacteria have different drug resistances.The drug resistances of Acinetobacter baumannii and Escherichia coli are serious.Therefore,it is necessary to monitor bacterial resistance,guide the use of antibiotics and control the production and spread of drug-resistant strains.