2009年至2012年医院革兰阴性杆菌的分布及耐药性分析

目的了解医院4年革兰阴性菌分离率与药物敏感性变化，为指导临床合理用药提供可靠依据。方法对2009年1月至2012年 12月医院临床分离的革兰阴性菌的菌株分布及药物敏感性变化进行回顾性调查，采用WHONET5.4软件进行数据分析。结果共分离出常见的革兰阴性菌4 861株，其中以大肠埃希菌（29. 48% ）、肺炎克雷伯菌（21. 85% ）、鲍曼不动杆菌（19. 15% ）、铜绿假单胞菌 （17.00%）为主。肺炎克雷伯菌和大肠埃希菌超广谱P-内酰胺酶（ESBU）的平均检出率分别为33.28%和50. 17%。大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对亚胺培南、美罗培南和哌拉西林他唑巴坦保持较高的敏感性。铜绿假单胞菌和鲍曼不动杆菌对多数抗菌药物高度耐药，且耐药率呈逐年上升趋势。结论该院临床常见革兰阴性菌耐药现象日趋严重，应加强革兰阴性杆菌检测和耐药性动态监测，以指导临床进行合理规范的抗感染治疗。

Analysis of Distribution and Drug Resistance of Gram - Negative Bacteria in Our Hospital from 2009 to 2012

Objective To investigate the changes of the isolation rate of Gram - negative bacteria and the drug susceptibility in our hos- pital during the recent 4 years in order to provide the basis for guiding clinical rational drug use. Methods The changes of the strains distribution of Gram - negative bacteria clinically isolated from 2009 to 2012 and the drug susceptibility were performed the retrospec- tivel investigation and statistically analyzed by the WHONET 5.4 software. Results 4 861 strains of commonly Gram - negative bacteria were isolated, in which, the main strains were Escherichia coli（29. 48% ）, Klebsiella pneumoniae （21. 85% ） , Acinetobacter baumannii （19. 15% ） and Pseudomonas aeruginosa （17.00% ）.The average detection rates of extended spectrumbeta - lactamase （ESBLs） in Kleb- siella pneumoniae and Escherichia coli was 33.28% and 50. 17% , respectively. Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae kept high sensibility to imipenem, meropenem and piperacillin/tazobactam. Pseudomonas aeruginosa and Acinetobacter baumannii kept high resistance to most antibbacterial agents and showed the increasing trend year by year. Conclusion The drug resistance status of commonly clinical Gram - negative bacteria in our hospital is more and more serious. The detection of Gram - negative bacteria and the dynamic monitoring of drug resistance should be strengthened so as to instruct the clinicians to conduct reasonable and normative anti - infectious medication.