2000-2010年医院革兰阴性杆菌耐药性分析  

Drug resistance of gram-negative bacilli in Hospital of 2000-2010

作　　者：黎斌斌[1] 刘颖梅[1] 栗方[1] 王珊珊[1] 郭萍[1] 杨春霞[1] 王春雷[1] 曹彬[1] 

机构地区：[1]首都医科大学附属北京朝阳医院感染和临床微生物科,北京100020

出　　处：《中华医院感染学杂志》2012年第23期5379-5382,共4页Chinese Journal of Nosocomiology

摘　　要：目的分析北京朝阳医院2000-2010年临床分离的革兰阴性杆菌的耐药变迁,以指导临床合理使用抗菌药物。方法 2000-2007年分离的非重复16 344株革兰阴性杆菌采用MIC法进行药敏试验,2008-2010年分离的非重复9211株革兰阴性杆菌采用K-B法进行药敏试验,数据分析采用WHONET5.4软件。结果 25 555株临床分离的革兰阴性杆菌中分离率较高的前9位病原菌依次为大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌、阴沟肠杆菌、嗜麦芽寡养单胞菌、洋葱伯克霍尔德菌、褪色沙雷菌、产气肠杆菌,分别占18.7%、15.8%、12.6%、10.8%、6.9%、3.9%、3.0%、2.2%、1.6%,大肠埃希菌和肺炎克雷伯菌产ESBLs检出率分别为52.5%、33.6%;肠杆菌科细菌对亚胺培南和美罗培南仍保持高度敏感,耐药率为0～0.3%;鲍氏不动杆菌对亚胺培南的耐药率2000年为3.9%、2010年为58.9%,呈明显上升趋势;头孢他啶、头孢吡肟、哌拉西林、哌拉西林/他唑巴坦和阿米卡星对铜绿假单胞菌维持着较高的抗菌活性,耐药率均<20.0%;而铜绿假单胞菌对亚胺培南的耐药性呈上升趋势,16.3%～33.6%。结论细菌耐药率明显升高,碳青霉烯类抗菌药物对临床常见的革兰阴性杆菌虽然保持着较高的抗菌活性,但耐碳青霉烯类鲍氏不动杆菌数量大大增加,并且已出现5株耐碳青霉烯类肠杆菌科细菌。OBJECTIVE To investigate the change of antimicrobial resistance of the gram-negative bacilli in Beijing Chaoyang Hospital from 2000 to 2010 so as to guide the reasonable use of antibiotics. METHODS The antimicrobial susceptibility of 16 344 strains of gram-negative bacilli from 2000 to 2007 was tested by MIC method. Antimicrobial susceptibility of 9211 strains of non-repetitive gram-negative bacilli from 2008 to 2010 was determined by the disk diffusion method, the WHONET 5.4 software was used to analyze the data. RESULTS Of 25555 clinical isolates of gram-negative bacilli isolated, the top nine isolated species were Escherichia coli ,Pseudo- monas aeruginosa , Acinetobacter baumannii , Klebsiella pneumoniae , Enterobacter cloacae, Stenotrophornonas mal- tophilia , Burkholderia cepacia , Serratia marcescens , and Enterobacter aerogenes , accounting for 18.7 %, 15.8 %, 12.6 %, 10.8%, 6.9 %, 3.9 %, 3.0 %, 2.2 %, andl. 6 %, respectively. The detection rates of ESBLs-producing E. coli and K. pneumoniae were 52.5% and 33.6%, respectively. Enterobacteriaceae remained highly susceptible to imipenem and meropenem, with the drug resistance rates ranging from 0% to 0.3%; the drug resistance rate of A. baurnannii to imipenem was 3.9% in 2000 and 57.8% in 2009, presenting a significant upward tendency; P. aeruginosa kept high antibacterial activity against ceftazidime, cefepime, piperacillin, piperacillin-tazobactam, and amikacin, with all the drug resistance rates less than 20. 0%; the drug resistance rate of P. aeruginosa to imipenem kept an upward tendency, varying from 16.3% to 33.6%. CONCLUSION The bacterial drug resistance rate is significantly elevated. The common clinical gram-negative bacilli remain highly resistant to carbapenems antibiotics, and the carbapenems-resistant A. baumannii isolates have been increased, and 5 strains of carbapenems-resistant Enterobacteriaceae isolates have emerged.

关 键 词：革兰阴性杆菌 耐药性 碳清霉烯类 抗菌药物 

分 类 号：R378[医药卫生—病原生物学]