临床分离主要革兰阴性杆菌的耐药性分析

目的 探讨临床分离主要革兰阴性杆菌的分布及对抗生素的耐药性。方法 对我院自2000年1月至2003年12月临床分离的4179株革兰阴性细菌进行分离鉴定和药敏试验，并通过回顾性分析。结果 4179株革兰阴性杆菌中位居前几位的分别是大肠埃希菌1519株（18．4％）；铜绿假单胞菌747株（9．0％）；肺炎克雷伯菌485株（5．9％）；阴沟肠杆菌321株（3．9％）；不动杆菌277株（3．4％）。肺炎克雷伯菌对氨曲南、亚胺培南、头孢曲松、头孢噻肟、头孢他啶较为敏感，大肠埃希菌对氨曲南、亚胺培南、头孢曲松、头孢他啶、头孢噻肟、阿米卡星较为敏感，铜绿假单胞菌仅对亚胺培南十分敏感，氯曲南、头孢他啶也有一定作用。肺炎克雷伯菌和大肠埃希菌产ESBL菌株检出率分别是39．9％、32．8％，且其耐药性除亚胺培南外较非产ESBL菌株明显增高（P〈0．05）。结论 大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌仍然是我院感染的主要细菌，耐药性较高，尤其是产ESBL菌株，因此应加强对细菌耐药性的全面监测，合理使用抗生素。

Analysis of drug resistance of the common gram negative bacillus in nosocomial infection

Objective To monitor distribution of the common gram negative bacillus in nosocomial infection and resistance to antimicrobial agents. Methods 4 179 gram negative becteria isolated from patients in our hospital from Jan 2000 to Dec 2003 were identified and antimicrobial susceptibitity test was performed. Results According to components of bacteria, 50.6% of them were gram-negative bacteria ,in which the most common pathogens were Escherichia coli (1 519,18.45%),Pseudom onas aerug inosa (747,9.0%), Klebsiella pneumoniae (485,5.9%), Enterobacter (321,3.9%) and A cinetobacter (277,3.4%). The resistant rates of Escherichia coli to aztreonam,imipenem,ceftriaxone,cefotaxime,ceftazidime,amikacin were low.The resistant rates of pseudomonas aeruginosa to aztreonam imipenem, ceftriaxone, cefotaxime, ceftazidime were also low. There were 39.9%,32.8% of ESBL prducing Klebsiella pneumoniae and Escherichia coli . The resistance rates of ESBLs producing steains to antibiotics were higher than those of non-ESBLs producer( P <0.05). Conclusion The three common species are K. pneumopice, E.coil and P.aeruginosa which are high drug-resistance to most common antibiotics,especially the ESBLs producers. The supervision towards bacterium Gram-negative and reasonable advice shall be given.