常见革兰阴性杆菌的耐药性分析

目的 分析医院2011年临床分离革兰阴性杆菌的耐药性及超广谱β-内酰胺酶(ESBLs)菌株的检出率.方法 采用纸片扩散法进行药敏试验,按NCCLS 2004年标准判读结果,用双相纸片法进行产ESBLs菌株确证.结果 从各种标本分离到3390株革兰阴性杆菌,检出340株产ESBLs菌株,检出率为10.0％,其中大肠埃希菌218株、肺炎克雷伯菌122株,分别占64.1％、35.9％；大肠埃希菌、阴沟肠杆菌对美罗培南、亚胺培南的敏感率均为100.0％,阴沟肠杆菌对阿米卡星耐药率最低,为29.7％,对其他抗菌药物耐药率均＞40.0％;鲍氏不动杆菌对头孢哌酮、氨曲南耐药率较高,分别为88.5％、78.5％,对亚胺培南、美罗培南、头孢西丁耐药率较低,分别为23.8％、24.2％、26.2％；铜绿假单胞菌对美罗培南、亚胺培南、阿米卡星敏感率较高,分别为69.0％、69.0％、73.3％.结论 革兰阴性杆菌耐药性呈上升趋势,特别是对头孢菌素类耐药显著,碳青霉烯类仍是目前对革兰阴性杆菌最有效的药物；产ESBLs菌株以大肠埃希菌多见；铜绿假单胞菌的耐药率逐渐升高,应引起注意.

Drug resistance of common gram-negative bacilii

OBJECTIVE To evaluate the nosocomial drug resistance of the common gram-negative bacilli and the detection rate of extended spectrum β-lactamase(ESBL)-producing strains in 2011.METHODS Drug susceptibility testing was performed with K-B method,the results were analyzed by NCCLS 2004.The ESBL-producing strains were all confirmed by ceftazidime/clavulanic and cefotaxime/clavulanic with diffusion method.RESULTS Among 3390 strains of gram-negative bacilli,there were 340 of ESBLs-producing strains with the detection rate of 10.0% including Escherichia coli(218,62.3%)and Klebsiella pneumoniae(122,47.1%).The results showed that the drug susceptibility rates of E.coli and Enterobacter cloacae to meropenem and imipenem were 100.0%,the drug resistance rate of E.cloacae was the lowest(29.7%),and the drug resistance rates to other antibiotics were above 40.0%;the drug resistance rates of Acinetobacter baumannii to cefoperazone and aztreonam were 88.5% and 78.5%,the drug resistance rates to imipenem,meropenem,and cefoxitin were 23.8%,24.2%,and 26.2%,respectively;the drug susceptibility rates of Pseudomonas aeruginosa to meropenem,imipenem,and amikacin were 69.0%,69.0%,and 73.3%,respectively.CONCLUSION The drug resistance of the gram-negative bacilli presents an upward trend,especially the drug resistance to cephalosporins,carbapenems remain as the most effective drugs against gram-negative bacilli;E.coli is the most common species of ESBLs-producing strains;the drug resistance rate of P.aeruginosa is increasing,which should be attached great importance.