湖南衡阳地区呼吸道感染革兰阴性杆菌的菌群分布及耐药性分析

目的了解本院近2年呼吸道感染革兰阴性杆菌菌群分布及常见致病菌的耐药情况。方法收集本院2006年10月~2008年10月临床送检的5914份痰标本,采用API鉴定系统进行菌株鉴定及药敏试验。结果共分离出1386株革兰阴性杆菌,最常见的呼吸道革兰阴性杆菌是铜绿假单胞菌(31.0%),其次是鲍曼不动杆菌(14.2%)、大肠埃希菌(12.6%)、肺炎克雷伯菌(11.3%)、阴沟肠杆菌(8.4%)、产酸克雷伯菌(7.6%)与嗜麦芽寡养单胞菌(4.6%)。主要革兰阴性杆菌均对头孢哌酮/舒巴坦敏感,且除嗜麦芽寡养单胞菌外对亚胺培南和美罗培南也均敏感。各主要致病革兰阴性菌对替卡西林、替卡西林/克拉维酸、头孢他啶、环丙沙星、头孢吡肟、哌拉西林/三唑巴坦、哌拉西林、庆大霉素与妥布霉素均耐药。产酸克雷伯菌产ESBLs的菌株高达52.8%,大肠埃希菌为46.0%,肺炎克雷伯菌为38.5%,肠杆菌科中产ESBLs菌株对青霉素类和头孢类抗生素耐药率明显高于非产ESBLs菌株。产ESBLs和非产ESBLs肠杆菌科细菌均对替卡西林、头孢噻吩、复方磺胺甲唑与阿莫西林耐药,而对亚胺培南、美罗培南与头孢哌酮/舒巴坦均敏感。结论呼吸道分离的革兰阴性杆菌均存在严重耐药问题,及时监测病原菌变化及耐药趋势以指导临床用药至关重要。

Distribution and drug resistance among Gram-negative bacteria from respiratory tract infections

Objective To investigate the distribution and drug resistance among Gram-negative bacteria from respiratory tract infections during the last two years in our hospital.Methods Of 59 14 sputum from Oct 2006 through Oct 2008 in our hospital were collected and analyzed,the API system was used to identify the pathogenic bacteria and conduct antibiotic susceptibility test.Results A total of 1386 Gram-negative bacteria were isolated.The most common microbe causing respiratory infections was P.aeruginosa(3 1.0%),followed by A.baumannii(14.2%),Escherichia coli(12.6%),K.peumoniae(11.3%),E.cloacac(8.4%),K.oxytoca(7.6%)and Stenotrophmomas maltophilia (4.6%).THe dominant Gram-negative pathogenic bacteria were sensitive to cefoperazone/sulbactam,and were sensitive to imipenem and meropenem (except Stenotrophmomas maltophilia).The dominant Gram-negative pathogenic bacteria were resistant to ticarcillin、ticarcillin/clavulanie acid、ceftazidime、ciprofloxacin、cefepime、piperacillin/tazobactam、piperacillin、gentamicin and tobramycin.The incidence of ESBLs was 52.8%in K. oxytoca、46.0%in E.coli and 38.5% in K. pneumoniae.ESBLs producing strains were more resistant to penicillin and cephalosprins than ESBLs of non producing strains.ESBLs producing strains and non ESBLs producing strains were resistant to ticarcillin、cefalotin、trimethoprim/sulfa and amoxicillin but only few strains were resistant to imipenem、meropenem and cefoperazone/sulbactam.Conclusions Drug resistance of isolated pathogenic bacteria from respiratory tract infection is a serious problem.Monitoring the change of pathogen and the trends of antimicrobial resistance is very important in guiding the antibiotic therapy.