医院感染中主要革兰阴性杆菌的分布及耐药性分析

目的：监测医院感染中的主要革兰阴性杆菌的分布，对抗生素的耐药性及其耐药变化趋势，为临床合理选择抗生素治疗感染性疾病提供理论依据。方法：采用纸片琼脂扩散法对临床分离的3992株革兰阴性杆菌进行药敏试验，用WHONET5按照NCCLS2000版对结果进行判定和统计。结果：受检的3992株革兰阴性杆菌中，大肠埃希菌980株，占24．6％，铜绿假单胞菌408株，占19．4％，肺炎克雷伯菌408株，占10．2％；呼吸道分离1549株、占38．8％，泌尿道分离1114株，占27．9％，血培养为271株、占6．8％；耐药率最低的是亚胺培南7．6％，其次为头孢哌酮／舒巴坦8．1％和阿米卡星14％。头孢他啶16．2％，大肠埃希菌对环丙沙星的耐药率为70．4％，嗜麦芽窄食单胞菌对复方新诺明耐药率为21．4％，铜绿假单胞菌对亚胺培南为11．7％，对环丙沙星为13％。结论：大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌仍然是医院感染的主要病原菌，洋葱伯克霍尔德菌、阴沟肠杆菌的检出率也呈上升趋势，并且有较高的耐药性，在医院感染中也仍引起足够的重视。

Analysis of resistance and distribution of the common gram negative bacillus in nosocomial infection

Objective By monitoring distribution of the common Gram Negative bacillus in nosocomial infection and trend of resistance to antimicrobial, the theoretical basis is offered to physicians who choose antimicrobial for infection disease. Methods The result was judged and analysed according to NCCLS, 2000 edition by WHONET5 software. 3 992 strains isolated from clinic were tested by KB disk. Results Among the 3992 strains of Gram negative Bacillus, the most common organisms were E.coli 980 (24.6%), P.aeruginosa 774 (19.4%), K.pneumoniae 408 (10.2%). 1 549 ( 38.8% ) of these strains are isolated from respiratory tract, 1 114 (6.8%) from urinary tract and 271(6.8%) from blood. The antimicrobial resistance patterns of these trains showed lowest resistance to Imipenem (7.6%), Cefoperazone/sulbactam (8.1%) and Amikacin (14%), Ceftazidime (16.2%). E.coli still show higher resistant rates to Ciprofloxacin (70.4%), S.maltophilia resistant rates to trimethoprim/sulfamethoxazole is 21.4%, and P.aeruginosa to Imipenem is 11.7%, to Ciprofloxacin (13%). Conclusion E.coli, P.aeruginosa and K.pneumoniae still have been the important pathogeny of nosocomial infection. The prevalence of B.cepacia and E.cloacae increased gradually and its resistant rates were higher, which should be paid attention to in nosocomial infection.