安徽省某医院多重耐药革兰阴性菌流行情况及耐药分析

目的:了解2011²013年我院临床分离多重耐药革兰阴性菌流行情况、耐药及变迁。方法:采用Vitek-32全自动微生物分析仪及纸片扩散法对分离菌进行鉴定及药敏实验。结果:3年期间临床分离多重耐药菌共1 905株,占分离病原菌的18.9%,其中革兰阴性菌占74.6%。分离出的多重耐药革兰阴性菌数依次为大肠埃希菌、肺炎克雷伯菌、醋酸钙鲍曼复合不动杆菌、铜绿假单胞菌。多重耐药大肠埃希菌、肺炎克雷伯菌对碳青霉烯类3年内均保持极低的耐药率,对头孢哌酮/舒巴坦虽保持高的敏感性,但耐药率呈增高趋势。多重耐药铜绿假单胞菌、鲍曼复合不动杆菌耐药率高,对常用抗生素耐药率多在50%以上,部分为泛耐药株。结论:多重耐药菌对常用抗菌药物耐药状况严重,需加强抗感染管理制度执行和多重耐药菌的监测,并根据药敏试验结果合理应用抗菌药物。

Epidemiological characteristics of multidrug-resistant gram-negative bacteria in a hospital in Anhui province and drug resistance analysis

Objective： To understand epidemiological characteristics,drug resistance and changing tendency of multidrug-resistant gram-negative bacteria isolated in our hospital during the period of 2011- 2013. Methods： Vitek-32 automatic microbial analyzer was used to identify the bacteria isolated and disc diffusion method for examining the drug susceptibility. Results： In a 3-year period,a total of 1905 multidrug-resistant bacteria strains were identified,which accounted for 18. 9% of the pathogenic bacteria,and 74. 6% were gram-negative bacteria. The isolated multidrug-resistant gram-negative bacteria were sequentially with Escherichia coli,Klebsiella pneumoniae,Calcium acetate composite acinetobacter baumann and Pseudomonas aeruginosa. Escherichia coli and Klebsiella pneumonia of multidrug-resistance remained lower drug resistance rate for Carbapenems in 3 years. Although the bacteria maintained high sensibility to Cefoperazone-sulbactam,the drug resistance rate tended to increase. Higher resistance rates were found for multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii,in which over 50% were resistant to conventional individual antibiotics,and worse enough,some of the strains were pan-drug resistance. Conclusion： Resistance to conventional individual antibiotics appears serious in hospital setting among multidrug-resistant gram-negative bacteria. The findings suggest that it is urgent to practice stringent management system for antibiotic use and close supervision over multidrug-resistant bacteria,and infection control inventions shall be on rational basis of drug sensitivity test.