β内酰胺类药物的抗菌活性研究

目的 了解2007至2009年我院临床分离的致病菌对β内酰胺类药物的敏感性,指导临床合理用药.方法 采用Whonet软件,对2007至2009年度分离的2193株病原菌进行分析,采用法国梅里埃VITEK 2 Compact全自动细菌培养鉴定仪进行细菌鉴定和药物敏感试验(MIC法).结果 致病菌的分离数仍以革兰阴性杆菌为主(6种,1460株,占66.6%),分离数前10位的细菌依次为大肠埃希菌(614株,占28.0%)、铜绿假单胞菌(345株,占15.7%)、肺炎克雷伯菌(231株,占10.5%)、鲍曼不动杆菌(151株,占6.9%)、金黄色葡萄球菌(150株,占6.8%)、表皮葡萄球菌(74株,占3.4%)、阴沟肠杆菌(64株,占2.9%)、黏质沙雷菌(55株,占2.5%)、粪肠球菌(54株,占2.5%)、屎肠球菌(48株,占2.2%).614株大肠埃希菌和231株肺炎克雷伯菌中产超广谱β内酰胺酶的检出率分别为33.6%(206株)和46.3%(107株);150株金黄色葡萄球菌中耐甲氧西林的金黄色葡萄球菌检出率为64.7%,74株表皮葡萄球菌中耐甲氧西林的表皮葡萄球菌检出率为78.4%.β内酰胺类药物中的亚胺培南、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟对大多数革兰阴性杆菌有较好的抗菌活性.结论 细菌耐药性呈上升趋势,耐甲氧西林的葡萄球菌和产超广谱β内酰胺酶的菌株检出率逐年递增,应引起重视.

Abstract：

Objective To analyze drug resistance of bacteria isolated during 2007 to 2009 in our hospital and to guide rational administration of clinical medication. Methods Totally 2193 pathogens isolated at 2007-2009 by Whonet software were anlyzed, and bacterial identification and drug susceptibility testing (minimum inhibitory concentration method) by the French Merieux VITEK 2 Compact automated bacterial culture Identification System were observed. Results The separation rate of gram-negative bacterium was the highest (66.6%), followed by Escherichia coli (28.0%), Pseudomonas aeruginosa ( 15.7% ), Klebsiella pneumoniae ss. pneumonia ( 10.5% ),Acinetobacter baumannii (anitratus) (6.9%), Staphylococcus aureus (6.8%), Staphylococcus epidermidis (3.4% ), Enterobacter cloacae (2.9%), Serratia marcescens (2.5%), Enterococcus faecalis (2.5%) and Enterococcus faecium (2.2%). Detection rates of 614 Escherichia coli and 231 Klebsiella pneumoniae ss. pneumonia which produce extended spectrum beta-lactamases (ESBLs) were 33.6% and 46. 3%. The methicillin-resistant staphylococcus aureus detection rate of 150 Staphylococcus aureus was 64.7% and the methicillin-resistant staphylococcus(MRS) epidermidis detection rate of 74 Staphylococcus epidermidis was 78.4%. Imipenem, PiperacillinTazobactam Sodium, Ceftazidime and Cefepime inβ-Lactam medicaments for most gram-negative bacterium had good activity. Conclusion Drug resistance of bacteria has the trend of ascent and the MRS and ESBLs detection rates are increasing year by year.