重症监护患者感染革兰阴性杆菌对抗菌药物体外抗菌活性的比较

目的 研究重症监护患者感染革兰阴性杆菌的耐药性，为急危重症患者感染的治疗提供依据。方法 采用E试验法测定同济医院重症监护病房分离的200株革兰阴性杆菌对13种抗菌药物的最小抑菌浓度，用WHONET-4完成数据分析。结果 主要病原菌依次为铜绿假单胞菌(23．5％，47／200)，大肠埃希菌(20％，40／200)，肠杆菌属(16．5％，33／200)，克雷伯菌属(15％，30／200)，不动杆菌属(11．5％，23／200)，嗜麦芽窄食单胞菌(5％，10／200)。13种抗菌药物对革兰阴性杆菌的敏感覆盖率为：亚胺培南较高(90％)，其它依次为阿米卡星、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦、头孢他啶、环丙沙星，敏感率为61％～77％。大多数抗菌药物敏感性较以往文献报道明显下降。结论 治疗急危重症患者感染革兰阴性杆菌较有效的抗菌药物依次为：亚胺培南、阿米卡星、头孢哌酮／舒巴坦。

In vitro Activity Comparison of Antibiotics against Gram-negative Bacteria Isolated from Patients in ICU

Objective To study Gram negative bacteria resistance of the patients in ICU. Methods The minimum inhibitory concentrations (MICs) of 13 antibiotics against 200 Gram negative bacteria isolated from patients in ICU in our hospital were determined by E test method. A WHONET4 computer software was used to analyze the data. Results The main organisms were P. aeruginosa (23 5%, 47/200), E.coli (20%, 40/200), Enterobacter (16 5%, 33/200), Klebsiella (15%, 30/200), Acinetobacter (11 5%, 23/200), and X. maltophilia (5%, 10/200). Susceptibility to imipenem/cilastatin (90 %) was higher than others. Susceptible rates of amikacin, cefoperazone/sulbactam, piperacillin/tazobastam, ceftazidime, ciprofloxacin were from 61% to 77 %. The present susceptibility of most antibiotics was lower than that of previous study obviously. Conclusion The effective antibiotics to treat the patients infected with Gram negative bacteria in ICU were imipenem/cilastatin, amikacin, cefoperazone/sulbactam, orderly.