2010-2013年广西壮族自治区脑科医院革兰阴性菌的分布与耐药性分析

目的了解广西壮族自治区脑科医院临床常见革兰阴性菌的分布及耐药性变迁,为指导临床合理使用抗菌药物提供可靠依据。方法回顾性分析2010-2013年广西壮族自治区脑科医院临床各科室送检标本分离的革兰阴性菌及其耐药性进行回顾性调查分析。结果 4年间送检标本共分离出7 450株病原菌,主要以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和阴沟肠杆菌为主,检出率依次为28.4%、20.9%、18.7%、15.2%、6.2%。4年间大肠埃希菌和肺炎克雷伯菌超广谱β-内酰胺酶（ESBLs）的平均检出率分别为56.3%、36.9%。药敏结果显示,不同菌属对抗生素的耐药率有差别,肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌对碳青霉烯类抗菌药物总体上有较高的敏感性;铜绿假单胞菌对喹诺酮类、亚胺培南、头孢哌酮/舒巴坦耐药率相对较低;鲍曼不动杆菌对多数抗菌药物高度耐药,且呈逐年上升趋势。结论广西壮族自治区脑科医院临床常见革兰阴性菌对常用抗菌药物耐药严重,应加强革兰阴性菌耐药性的动态监测,以指导临床进行合理规范的抗感染治疗。

Clinical analysis of Gram-negative bacteria distribution and drug resistance in Brain Hospital of Guangxi Zhuang Autonomous Region from 2010 to 2013

Objective To investigate the distribution and antimicrobial resistance of common Gram-negative bacteria in Brain Hospital of Guangxi Zhuang Autonomous Region during 2010 to 2013, and to instruct the reasonable clinical application of antibiotics. Methods The clinical data and drug resistance of Gram-negative bacteria isolated from various clinical specimens from 2010 to 2013 were reviewed retrospectively. Results All of 7 450 Gram-negative bacteria were isolated, and the main strains were Escherichia coli （28.4 %）, Klebsiella pneumoniae （20.9%）, Pseudomonas aeruginosa （18.7%）, Acinetobacter baumannii （15.2%）, and Enterobacter cloacae （6.2%）. The extended spectrum β-1actamases （ESBLs） orE. coli and K. pneumoniae were 56.3% and 36.9%, respectively. The rates of sensitive to antimicrobial agents were different between bacteria. K. pneumoniae, E. coli, and E. cloacae kept high sensibility to imipenem, meropenem, and piperacillin/tazobactam. P. aeruginosa had the low drug resistance to imipenem and cefoperazone/sulbactam. P aeruginosa kept high resistance to most antibiotics and increased year by year. Conclusion The drug resistance status of common clinical Gram-negative bacteria in Brain Hospital of Guangxi Zhuang Autonomous Region is more and more serious. People should strengthen the detecting of pathogens and monitoring of bacterial drug resistance, so as to instruct the clinicians to have anti-infectious remedy reasonably and normatively.