下呼吸道感染革兰阴性杆菌分布及耐药分析  

Distribution and drug resistance analysis of Gram-negative bacteria in lower respiratory tract infections

作　　者：郭婧[1] 高鸿敏[1] 

机构地区：[1]北京军区总医院263临床部,北京101149

出　　处：《发育医学电子杂志》2013年第4期201-204,共4页Journal of Developmental Medicine (Electronic Version)

摘　　要：目的：分析呼吸内科下呼吸道感染住院患者革兰阴性杆菌分布及耐药性变化情况，为临床合理用药提供依据。方法分析2010年11月至2011年11月我院呼吸内科下呼吸道感染患者痰标本分离出的176株革兰阴性菌及耐药情况。结果我院呼吸科病房主要致病的革兰阴性菌依次为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、嗜麦芽窄食单胞菌、阴沟肠杆菌等；52株铜绿假单胞菌中对左氧氟沙星、哌拉西林/舒巴坦耐药率分别为21.1%和21.4%；对美罗培南、亚胺培南的耐药率分别为38.2%、48.9%；对阿米卡星、头孢哌酮/舒巴坦、头孢吡肟、头孢他啶、氨曲南等耐药率在26.0%～45.0%，对氨苄西林、氨苄西林/舒巴坦、其他头孢类测试药物的耐药率均在80%以上。21株鲍曼不动杆菌对所测试药物均显示较高耐药性，除阿米卡星及哌拉西林/他唑巴坦相对较低外，对美罗培南及亚胺培南耐药率达到42.4%和50.0%，对氨苄西林和一代头孢、二代头孢耐药率接近100%。嗜麦芽窄食单胞菌对左氧氟沙星、复方新诺明耐药率分别为27.3%、14.3%，对米诺环素仍呈敏感；大肠埃希菌和肺炎克雷伯菌ESBLs 的总检出率分别为72.7%和16.6%，大肠埃希菌产ESBLs株对庆大霉素、环丙沙星、左氧氟沙星及大多数B内酰胺酶类药物的耐药率在90.0%以上。肠杆菌科细菌中不同菌种对碳青霉烯类、哌拉西林他唑巴坦敏感率100%。结论革兰阴性菌是呼吸内科病房内感染的主要致病菌，对各种抗生素均呈不同程度耐药，为控制耐药菌株的产生和扩散，抗生素的合理使用和细菌耐药性的监测尤为重要。Objectives To provide the evidence for treatment to lower respiratory tract infections, a study on distribution and drug resistance analysis of Gram-negative bacteria was conducted in the department of respiratory. Methods Sputum samples were collected from inpatients with lower respiratory tract infections in department of respiratory of our hospital from November 2010 to November 2011. Gram-negative bacteria from these samples was isolated, then the distribution and drug resistance analysis of these bacteria was conducted. Results In respiratory ward of our hospital, the main pathogenic Gram-negative bacteria were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, maltophilia Aeromonas, Enterobacter cloacae, etc. Of the 52 specimens were positive for Pseudomonas aeruginosa,levofloxacin, piperacillin/sulbactam resistance rates were 21.1%and 21.4%, respectively, Resistance rate to meropenem, imipenem were 38.2%, 48.9%;amikacin, cefoperazone/sulbactam, cefepime, ceftazidime, aztreonam resistance rate at 26.0%-45.0%, ampicillin, ampicillin/sulbactam, other cephalosporin resistance rates of drug testing in more than 80%.21 Acinetobacter baumannii tested for drugs showed high resistance, in addition to amikacin and piperacillin/tazobactam is relatively low, the meropenem and imipenem were 42.4%and 50.0%, ampicillin, and generation cephalosporins, second-generation cephalosporin resistance were close to 100%. Maltophilia Aeromonas levofloxacin, cotrimoxazole resistance rates were 27.3%, 14.3%, respectively, continued to show sensitivity to minocycline. Escherichia coli and Klebsiella pneumoniae ESBL s overall detection rate was 72.7%and 16.6%, respectively, of the E. coli strains producing ESBLs gentamicin, ciprofloxacin, levofloxacin, and most B amide enzymes of drug resistance rates above 90%. Different strains of Enterobacteriaceae to carbapenems, piperacillin tazobactam rate of 100%.Conclusion Gram-negative bacteria were major pathogens in the respiratory ward, They show

关 键 词：下呼吸道感染 微生物学 耐药性 细菌 

分 类 号：R446.5[医药卫生—诊断学]