广州地区3500株革兰阴性细菌的分布特征及耐药性特点  

Distribution and drug-resistance of 3 500 gram-negative bacteria in Guangzhou

作　　者：肖庆忠[1] 苏丹虹[1] 江洁华[1] 钟南山[2] 

机构地区：[1]广州医学院第一附属医院检验科,广东广州510120 [2]广州医学院第一附属医院呼吸疾病研究所,广东广州510120

出　　处：《第一军医大学学报》2005年第2期132-138,共7页Journal of First Military Medical University

基　　金：广州市科技局重大攻关项目(2000-Z-027-01-2)~~

摘　　要：目的了解广州地区医院感染常见革兰阴性细菌分布特征和耐药特点.方法2001年7月～2003年8月,用Kirby-Bauer法检测了从广州地区13家医院分离获得的3 500株革兰阴性细菌对临床常用15～21种抗生素的药敏结果,并按美国临床实验标准委员会2000年判断标准进行判断,用WHONET-5软件分析数据.结果分离出的3 500株革兰阴性菌中前3位细菌依次是大肠埃希菌(Escherichia coli,ECO)1 244株(占35.5%)、肺炎克雷伯菌(Klebsiellapneumoniae,Kpn)900株(占25.7%)和铜绿假单胞菌(Pseudomonas aeruginosa,Pae)547株(占15.6%).广州地区临床分离革兰阴性菌中产超广谱β内酰胺酶(extended-spectrumbeta-lactamases,ESBLs)菌株的总检出率为31.0%(1 084/3 500),在各种常见菌属中的检出率分别为:大肠埃希菌为38.7%(482/1 244)、肺炎克雷伯菌为37.9%(341/900)、铜绿假单胞菌为5.3%(29/547)、阴沟肠杆菌为55.2%(117/212)、不动杆菌属为8.2%(17/208)、其他肠杆菌属为27.7%(53/191)、嗜麦芽窄食单胞菌为33.3%(37/117)、变形杆菌属为9 2%(8/87).从呼吸道标本中分离获得革兰阴性细菌最多,为1 463株(占41.8%);其次为泌尿道标本,为943株(占26.9%).耐药性分析显示:革兰阴性杆菌对临床常用抗生素的总体耐药率最低为亚胺培南(8.7%),其次为头孢哌酮/舒巴坦(13.3%),而最高为氨苄西林(90.5%),其次为奈啶酸(69 3%).亚胺培南对广州地区临床分离的大肠埃希氏菌、肺炎克雷伯氏菌、阴沟肠杆菌、不动杆菌属、其他肠杆菌属和变形杆菌属的耐药率最低,分别为1.1%、0.5%、0.6%、3.2%、0.8%和0%,而头孢哌酮/舒巴坦对广州地区临床分离的铜绿假单胞菌和嗜麦芽窄食单胞菌的耐药率最低,分别为10.8%和15.9%,大部分细菌呈多重耐药.产ESBLs菌株对15～21种临床常用抗菌药物的耐药率均显著高于不产ESBLs菌株(P＜0.05).结论细菌耐药性仍是目前广州地区临床用药最为严重的问题,尤其是产ESBLs菌株有上升�Objective To investigate the distribution and drug-resistance of the common gram-negative bacteria in Guangzhou. Methods From July 2001 to August 2003, the resistance of 3 500 strains of common gram-negative bacteria isolated from 13 hospitals in Guangzhou to 15 to 21 antibiotics was determined by standard Kirby-Bauer method according to the guidelines of the National Committee for Clinical Laboratory Standards (NCCLS, 2000). WHONET-5 software was used to analyze the data. Results Totally 3 500 gram-negative bacterial strains were isolated from 13 hospitals in Guangzhou in the past two years, and the top 3 most common pathogens of them were Escherichia coli (1 244 strains, 35.5%), Klebsiella pneumoniae (900 strains, 25.7%), and Pseudomonas aeruginosa (547 strains, 15.6 %). The total prevalence of extended-spectrum β-lactamases (ESBLs)-producing strains was 31.0% (1 084/3 500). The prevalences of ESBLs-producing strains in the Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterobacter cloacae, Acinetobacter SP., other Enterobacter SP., Stenotrophomonas maltophilia, and Proteus SP. in Guangzhou were 38.7%, 37.9%, 5.3%, 55.2%, 8.2%, 27.7%, 33.3% and 9.2%, respectively. Among them, 1 463 (41.8%) strains was isolated from the respiratory tract and 943 (26.9%) from the urinary tract. According to our surveillance, the clinical antibacterial drug with the lowest total drug-resistance rates of Gram-negative bacteria was imipenem (8.7%) followed by Cefoperazone/sulbactam (13.3%), while that with the highest resistance was ampicillin (90.9%) followed by nalidixic acid (69.3%). Imipenem was the most effective agents against Escherichia coli, Klebsiella pneumoniae, Entero- bacter cloacae, Acinetobacter SP., other Enterobacter SP., and Proteus SP. isolated from 13 hospitals in Guangzhou, with drug-resistant rates of 1.1%, 0.5%, 0.6%, 3.2%, 0.8% and 0%, respectively, whereas the most effective agents against Pseudomonas aeruginosa and Stenotrophomonas maltophilia was cefoperazone/sulbactam, with the drug-

关 键 词：革兰氏阴性菌 抗药性 微生物 交叉感染 细菌分布 Β内酰胺酶类 

分 类 号：R446.5[医药卫生—诊断学]