下呼吸道感染分离革兰阴性杆菌的耐药性分析  

Analysis of antibiotic resistance of gram-negative bacilli isolated from lower respiratory tract infections

作　　者：裴丽淑[1] 于树云[1] 葛庚芝[1] 

机构地区：[1]天津医科大学第二医院呼吸科,天津300211

出　　处：《临床荟萃》2011年第12期1016-1018,共3页Clinical Focus

摘　　要：目的分析我院下呼吸道感染患者临床分离常见革兰阴性细菌对常用抗菌药物的耐药性,指导临床合理使用抗菌药物。方法收集下呼吸道感染患者痰或支气管肺泡灌洗液,常规细菌培养、分离后,经VITEK-AMS 60自动分析仪鉴定,应用K-B法测定对抗菌药物的敏感性。结果临床分离常见革兰阴性杆菌前3位依次为不动杆菌属(25.4%)、铜绿假单胞菌(16.2%)、肺炎克雷伯杆菌(15.4%)。不动杆菌属细菌对第3代头孢菌素中的头孢哌酮/舒巴坦(4.0%)和头孢他啶(4.0%)、第4代头孢菌素(4.0%)、氟喹诺酮类(10.8%)、氨基糖甙(10.8%)及亚胺培南(9.5%)耐药率较低。铜绿假单胞菌对头孢吡肟耐药率最低(4.3%),其次分别是左氧氟沙星(19.1%)、阿米卡星(25.2%)、环丙沙星(25.5%),对亚胺培南的耐药率高达55.3%。肺炎克雷伯杆菌除哌拉西林耐药率19.1%外,对常用抗生素的耐药性相对较低。结论我院下呼吸道感染分离革兰阴性杆菌以不动杆菌位居首位,常见革兰阴性杆菌对抗生素呈不同程度耐药性。铜绿假单胞菌对亚胺培南耐药现象十分严重,应根据药敏结果用药。加强对院内感染和本地区、本院及本病区临床分离菌的耐药监测,对合理经验选择抗生素非常重要。Objective To analyze the resistance of antibiotics of gram-negative bacilli isolated from patients with lower respiratory tract infection and help clinicians using antibiotics properly.Methods Isolates from patients＇ sputums or bronchoalveolar lavage fluids（BALF） were collected,and identified with VITEK-AMS 60 autoanalyzer system,the susceptibilities to antibiotics were detected by Kirby-Bauer method.Results The most common three gram-negative bacilli from lower respiratory tract infections were Acinetobacter spp（25.4%）,Pseudomonas aeruginos（16.2%）,Klebsiella pneumonia（15.4%）.Acinetobacter spp showed lower resistance to Cefoperazone/Sulbactam（4.0%）,Ceftazidime（4.0%） and the fourth cephalosporins（4.0%）,fluroqunolones（10.8%）,aminoglycosides（10.8%） and imipenem（9.5%）.Cefepime（4.3%） may be the first choice to control the infections of Pseudomonas aeruginosa,the second choice may be levofloxacin（19.1%）,amikacin（25.5%）,ciprofloxacin（25.5%）,but 55.3% of pseudomonas aeruginosa were resistant to imipenem.Klebsiella pneumoniae demonstrated 19.1% resistant to piperacillin and showed lower resistance to the other antibiotics tested.Conclusion Acinetobacter spp was most common bacilli isolated from lower respiratory tract infections in the hospital.Exception for Pseudomonas aeruginosa being severe resistant to imipenem,most gram-negative bacilli demonstrated different susceptibilities to common antibiotics.So,it is essential to monitor the bacterial susceptibilities to antibiotics,and it is very important for clinicians to choose proper antibiotics according to bacterial susceptibilities to antibiotics within local area and hospital,especially in choosing antibiotics experientially.

关 键 词：呼吸道感染 革兰阴性菌 抗生素 微生物敏感性试验 

分 类 号：R563.1[医药卫生—呼吸系统]