医院感染革兰阴性细菌耐药性分析

目的：探讨医院感染革兰阴性细菌的耐药性，为临床合理用药提供依据。方法：采用生物梅里埃公司的API系统及VITEK2系统进行细菌鉴定，用K-B法及VITEK2进行药敏试验，用WHONET5．4软件分析细菌的耐药性。结果：2475株革兰阴性细菌主要来源于痰、尿、血液及脓液，其中以铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌和嗜麦芽窄食单胞菌为主，分别占31．1％、13．9％、13．3％、11．4％和5．4％，产ESBLs的大肠埃希菌和肺炎克雷伯菌阳性检出率分别为49．1％和33．5％；美洛培南、亚胺培南、哌拉西林，他唑巴坦的耐药率最低，分别为19．7％、20．9％和26．5％。结论：铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌、嗜麦芽窄食单胞菌是医院感染的主要革兰阴性致病菌，加强耐药性监测，合理应用抗生素药物十分重要。

Drug resistance of Gram-negative bacteria from nosocomial infection

Objective ：To investigate the drug resistance of commonly encountered Gram-negative bacteria from nosocomial infection,and to provide reference for the clinical rational use of drugs. Methods：Gram-negative bacterium was identified by API and VITEK2 system,and its antimicrobial resistance was determined by Kirby-Bauer method and VITEK2 system. The antimicrobial resistance rates were analyzed by WHONET5.4 software. Results：Totally 2475 pathogens were mainly from phlegm,urine,blood and liquor puffs ;the most commonly encountered pathogens were Pseudomonas aeruginosa,Acinetobacter baumanmii, Klebsiella pneumoniae, Eseherichia coli ,S.maltophilia.The detection rates were 24.3%, 10.9%, 10.4% ,8.9% and 4.3% respectively,The positive rates of ESBLs from E.coli and Klebsiella pneumoniae were 49.1% and 33.5%.The resistant rate of MEM ,IMP and TZP were the lowest,which were 19.7%, 20.9% and 26.5% respectively.Conclusion：Pseudomonas aeruginosa, Acinetobacter, Klebsiella pneumoniae, Escherichia coli, S.mahophilia are still the major pathogenic bacteria in our hospital. It is very important to select antibiotics correctly according to the results of susceptibility tests.