152株阴沟肠杆菌的临床分布及耐药性分析

目的分析与探讨2005~2008年阴沟肠杆菌的临床分布及耐药情况,以指导临床合理用药,防止耐药菌株的传播。方法采用VITEK-32型和VITEK-2 Compact型微生物鉴定及药敏分析系统对152株阴沟肠杆菌,进行鉴定及耐药性分析,同时对2008年由ICU（重症监护病房）及非ICU病区分离出的54株阴沟肠杆菌的耐药性进行分析。结果 152株阴沟肠杆菌主要分布在呼吸道、分泌物、脓液、血液、尿液等;阴沟肠杆菌对大部分抗菌药物的耐药率呈上升趋势,该菌对第一代头孢菌素的耐药率高达91.7%~100.0%;对青霉素类抗生素的耐药率在80.9%~100.0%,其中氨苄西林的耐药率最高为100.0%;对氨基糖苷类的耐药率在34.6%~54.2%;2008年该菌对复方新诺明及头孢唑啉的耐药率分别为100.0%和91.7%,而非ICU（46株）和ICU（8株）病区中,对复方新诺明的耐药率最高分别为93.5%,87.0%,同时产ESBLs的阴沟肠杆菌的检出率为8.0%~9.7%,而对亚胺培南100%敏感。结论阴沟肠杆菌耐药率高,呈多重耐药现象。临床应在合理应用抗生素的同时严格消毒灭菌,遏制该菌引起的医院感染。

Clinical distribution and drug resistance of 152 enterobacter cloacae samples

Objective By analyzing the clinical distribution and drug resistance of enterobacter cloacae during 2005 to 2008,this paper aims to provide useful guidance to clinical doctors to use drug rationally and to prevent the spreading of drug-resistant strains.Methods We used VITEK-32 and VITEK-2 Compact microbial identification and drug sensitivity analysis system to analyze 152 enterobacter cloacae samples identify such samples and analyze their drug resistance.The author has also analyzed drug resistance of 54 enterobacter cloacae samples collected from the ICU and non-ICU wards in 2008.Results The 152 enterobacter cloacae samples were mainly distributed in respiratory tract,secretions,sanies,blood,urine etc.Enterobacter cloacae is becoming increasingly resistant against most antibioses,the bacteria showed a resistance rate as high as 91.7%~100% against first-generation cepholoporins,and 80.9%~100.0% against Penicillin antibiotics.The rate as against ampicillin even reached 100.0%.Its rate of resistance against aminoglycoside was 34.6%~54.2%.The rates of resistance against trimethoprim-sulfamethoxazole and cefazolin,as found in 2008,were 100.0% and 91.7% respectively.For samples collected from non-ICU wards（46 samples） and ICU wards（8 samples）,the rate of resistance against trimethoprim-sulfamethoxazole was as high as 93.5%,and 87.0% respectively.Tests have found ESBLs produced from 8.0%~9.7% of samples,and enterobacter cloacae is 100% sensitive to imipeneln.Conclusion Enterobacter cloacae shows high antimicrobial resistance rate and multi-drug resistance feature.Clinical doctors must use antibiotics rationally and disinfect strictly in order to prevent hospital infection caused by enterobacter cloacae.