下呼吸道感染革兰阴性杆菌谱及其耐药性分析

目的 了解本院呼吸内科病房下呼吸道感染患者分离细菌中革兰阴性(G-)菌谱及其耐药情况,为临床防治G-菌感染提供依据.方法 对呼吸内科2004年1月至2009年12月分离到的G-菌及其耐药性进行回顾性分析.结果 6年间共分离G-菌612株,占63.1%(612/970).G-菌分离率总的趋势逐年增多,其中2004年1月至2006年12月分离273株,2007年1月至2009年12月分离339株,G-菌分离率由前三年的28.1%上升到后三年的35.0%.而且分离的菌谱也有所不同,前三年分离率居前五位的G-菌分别是铜绿假单胞菌(33.5%)、肺炎克雷伯菌(13.0%)、不动杆菌(12.2%)、大肠埃希菌(11.7%)、阴沟肠杆菌(4.8%);后三年分离率居前五位的G-菌分别是铜绿假单胞菌(35.6%)、大肠埃希菌(13.5%)、不动杆菌(12.7%)、肺炎克雷伯菌(11.9%)、阴沟肠杆菌(4.3%).所有的G-菌均有较高的耐药性,对多数头孢三代药物耐药率较高.耐药率较低的抗生素主要有亚胺培南,舒普深,哌拉西林舒巴坦.其中碳青霉烯类抗生素对下呼吸道G-菌的敏感性在93%以上,而左氧氟沙星的耐药率较高(30%),与其他地区的研究报道基本一致[1].结论 下呼吸道G-菌感染的耐药是临床上面临的难题,需要进一步探讨研究,采取合理的方法降低耐药率的产生.

The spectrum and antibiotics resistance of gram-negative bacilli in the lower respiratory infection

Objective To get knowledge of the spectrum and antibiotics resistance of Gram - negative bacilli in the penumology department unit so as to provide the evidence for clinical treatment. Methods The G- isolated from penumology department unit and their antibiotics resistance were retrospectively analysed from January 2004 to December 2009. Results During the past 6 years,there were 612 G- strains in total were isolated from penumology department unit. The isolation rate of G- was increasing year by year and that was from 28.1% between January 2004 and December 2006（273 strains） up to 35.0% between January 2007 and December 2009 （339 strains）. The most frequent isolates were Pseudomonas aeruginosa （33.5%） , Klebsiella pneumoniae（ 13.0% ）, Acinetobacter spp （ 12. 2% ）, Esxherichia coli （ 11.7% ）, Enterobacter cloacae （ 4. 8% ） between January 2004 and December 2006; and Pseudomonas aeruginosa （35.6%） , Esxherichia coli （ 13.5% ） , Acinetobacter spp （ 12. 7% ） , Klebsiella pneumoniae（ 11.9% ） , Enterobacter cloacae（4. 3% ） between January 2007 and December 2009. High drug - resistance rates were found among all stains of pathogens to be against to the third generation eephalosporins except ceftazidime. The most sensitive agents against gram negative organisms were carbopenems （ Meropenem, Imipenem ） , with a susceptibility of more than 93% ,followed by Vancomycin and Aztreonam. In this study ,the druG resistance rate among Gram- negative bacterial from lower respiratory tract to Levofloxacin was 43%, the same with reports of other area. Conclusion DruG- resistance is still a serious clinical problem. An unanimous effective strategy for the solution of this problem is urgently needed.