革兰阴性菌临床分离株的分布及耐药性分析

目的探讨临床常见革兰阴性菌的分布特点及耐药现状，为临床用药提供参考。方法将临床送检标本按常规分离培养，采用法国生物梅里埃公司VITEK32全自动微生物鉴定系统进行鉴定；采用K-B法进行药敏试验，根据2008年版CLSI（临床实验室标准化协会）文件标准判断药敏结果。结果临床分离革兰阴性菌的构成主要为大肠埃希菌（35.4％）、肺炎克雷伯菌（29.9％）、铜绿假单胞菌（21.2％）。大肠埃希菌耐药率前3位是哌拉西林（81.7％）、四环素（76.0％）、环丙沙星（74.2％），耐药率最低的2位是亚胺培南（0.5％）、哌拉西林／他唑巴坦（2.9％）；肺炎克雷伯菌耐药率靠前的为哌拉西林（61.7％）、氯霉素（52.9％）、四环素（49.6％），耐药率最低2位是亚胺培南（0.7％）、哌拉西林／他唑巴坦（9.5％）；铜绿假单胞菌对氯霉素（94.8％）、复方新诺明（94.2％）、四环素（84.7％）耐药最为明显，对头孢他啶（21.7％）和亚胺培南（38.7％）敏感。结论大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌是临床革兰阴性菌感染的主要致病菌；常见革兰阴性菌对13种抗菌药物耐药严重，耐药率各不相同，铜绿假单胞菌耐药突出。

An analysis of clinical distribution and drug resistance of clinic Gram-negative bacteria isolates.

Objective To investigate distribution and drug resistance of clinic Gram-negative bacteria isolates, providing a reference for clinical medication. Methods Clinical samples were cultured routinely and identified with the French company bioMérieux VITEK32 automatic identification system. KB method was used for drug susceptibility testing according to the 2008 edition of Clinical Laboratory Standards Institute standard. Results Escherichia coli （35.4%）, Klebsielta pneumoniae （29.9%）, and Pseudornonas aeruginosa （21.2%） constituted the first three position of clinical isolates of Gram negative bacteria. The first three of the resistance rate of Escherichia coli were the Piperacillin （81.7%）, tetracycline （76.0%）, ciprofloxacin （74.2%）, and the lowest two of that were imipenem （0.5%）, piperacillin/tazobactam （2.9%） ; The top first three of the resistance rate of Klebsiella pneumoniae were piperacillin （61.7%）, chloramphenicol （52.9%）, tetracycline （49.6%）, and the lowest two of that were imipenem （0.7%）, piperacillin/tazobactam （9.5%） ; The top first three of the resistance rate of Pseudomonas aeruginosa were chloramphenicol （94.8%）, cotrimoxazole （94.2%）, tetracycline （84.7%）, and the relative sensitive antibiotics were ceftazidime （21.7%） and imipenem （38.7%）. Conclusion Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the top three of the clinical Gram-negative bacteria isolates; the resistance rate of the three bacteria to 13 antibiotics varies differently, while Pseudomonas aeruginosa display the most obvious resistance.