重症监护病房革兰阴性杆菌耐药性研究

目的　了解某院重症监护病房分离的革兰阴性 (G-)杆菌产超广谱 β 内酰胺酶 (ESBLs)和对常用抗菌药物的药敏情况。方法　采用浓度梯度法 (E test)检测 1 5 6株 (G-)杆菌的最低抑菌浓度 (MIC) ,并采用双纸片协同试验和纸片确证试验筛选和确认产ESBLs的菌株。结果　肠杆菌科非产ESBLs和产ESBLs的菌株总药物敏感率分别为 80 .4 6 %和 5 7.6 9% ,产ESBLs的大肠埃希菌、肺炎克雷伯菌和非产ESBLs的大肠埃希菌、肺炎克雷伯菌对头孢吡肟、头孢他啶等三代头孢菌素和加酶抑制剂复合抗菌药物及庆大霉素、环丙沙星等抗菌药物的耐药率差异有显著性 (P <0 .0 5 )。肠杆菌科菌株对第三代头孢菌素的耐药率以头孢他啶 1 4 .32 %为最低 ;对亚胺培南的耐药率 ,产ESBLs菌株和非产ESBLs菌株均为 0。铜绿假单胞菌和不动杆菌属对亚胺培南的耐药率分别为 4 0 .5 2 %和 8.82 %。结论　加强对细菌耐药性的监测 ,合理选择抗菌药物 ,对临床抗感染治疗十分重要

Study of antimicrobial resistance of the Gram-negative bacilli isolated from patients in intensive care units

Objective To study the antimicrobial resistance and producing of extended spectrum beta lactamases (ESBLs) of Gram negative bacilli isolated from patients in intensive care units in a hospital. Methods Using E test method to detect the minimal inhibitory concentration (MIC) of various antimicrobial agents against 156 strains of Gram negative bacilli, and double disc synergy test to confirm the ESBLs producing strains. Results The antimicrobial susceptibility rates of the ESBLs negative and ESBLs positive strains of Enterobacteriaceae was 80.46% and 57.69% , respectively. There was significant difference in the resistant rates to cefepime, ceftazidime, gentamycin and ciprofloxacin between the ESBLs positive and ESBLs negative strains of Escherichia coli and Klebsiella pneumoniae (P< 0.05 ). Strains of Enterobacteriaceae had the highest resistant rate ( 14.32% ) to the ceftazidime of the third generation cephalosporins, ESBLs positive and ESBLs negative strains of Enterobacteriaceae were all sensitive to imipenem. The resistant rates of Pseudomonas aeruginosa and Acinetobacter spp. to imipenem were 40.52% and 8.82% , respectively. Conclusion It is very important to select antimicrobial agents based on the results of antimicrobial susceptibility tests for the treatment of patients with infection.