下呼吸道感染革兰阴性杆菌谱及其耐药性分析  

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

作　　者：吴纯刚[1] 林立中[1] 

机构地区：[1]湖南省常德市第一人民医院,415003

出　　处：《浙江临床医学》2011年第5期496-498,共3页Zhejiang Clinical Medical Journal

摘　　要：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.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.

关 键 词：下呼吸道感染 革兰阴性杆菌 耐药性 

分 类 号：R56[医药卫生—呼吸系统]