革兰阴性菌耐药性特点与临床用药研究  

Characteristics of drug resistance and clinical medication of gram-negative bacteria

作　　者：郭世辉[1] 王威[2] 黄周[2] 孔晋亮[3] 巫艳彬[3] 吴聪[3] 蔡双启[3] 

机构地区：[1]广西医科大学第一附属医院检验科,广西南宁530021 [2]广西医科大学第一附属医院急诊科,广西南宁530021 [3]广西医科大学第一附属医院呼吸内科,广西南宁530021

出　　处：《中华医院感染学杂志》2015年第19期4401-4403,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81260002);广西教育厅基金资助项目(LX2014073);广西自然科学基金资助项目(2012GXNSFAA276011)

摘　　要：目的：分析2011－2013年医院感染病原菌的分布及耐药性特点，为抗菌药物的临床应用提供依据。方法于2011－2013年采集医院临床科室送检的痰液、尿液、血液、脓液、分泌物等标本，采用法国生物梅里埃公司生产的ATB Expression系统及ID 32 GN试剂盒进行细菌培养及鉴定，应用WHONET5．5软件分析其病原菌分布及耐药性。结果2011－2013年共分离病原菌26029株，其中革兰阳性菌5689株占21．8％，革兰阴性菌20340株占78．2％；标本来源居前3位的为痰液、尿液和血液；最常见的革兰阴性菌为大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌；鲍氏不动杆菌对头孢哌酮／舒巴坦耐药率最低为15．6％～30．9％，对碳青霉烯类的耐药率＞70．0％；铜绿假单胞菌对磺胺甲噁唑／甲氧苄啶耐药率最高，连续3年均为100．0％，对阿米卡星的耐药率最低为15．1％～27．8％。结论医院革兰阴性菌仍以大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌为主，其耐药性形势严峻，需继续密切监测医院病原菌的耐药变化趋势，并指导抗菌药物使用。OBJECTIVE To analyze the characteristics of distribution and drug resistance of pathogens causing infec‐tions in the hospital from 2011 to 2013 so as to provide references for clinical application of antibiotics .METHODS The sputum ,urine blood ,fester and secretions inspected in clinical departments were collected from 2011 to 2013 . ATB Expression system and ID 32 GN kit ,produced by French Bio‐Merieux company ,were adopted for bacterial identification .The bacterial distribution and drug resistance were analyzed by WHONET5 .5 software .RESULTS A total of 26029 strains of pathogenic bacteria causing hospital infections were collected from 2011 to 2013 ,inclu‐ding 5689 strains of gram‐positive bacteria ,which accounted for 21 .8% and 20340 strains of gram‐negative bacte‐ria ,which accounted for 78 .2% ;the most common gram‐negative bacteria pathogens were Escherichia coli , Pseudomonas aeruginosa ,Acinetobacter baumanii ,Klebsiella pneumoniae ,and Stenotrophomonas maltophilia . The sources of the specimen ranked the first 3 were sputum ,urine and blood .A .baumannii were the most sensi‐tive to cefoperazone/shubatan with the resistance rate of 15 .6% -30 .9% ,but were more resistant to carbapenems with the rate over 70 .0% .The drug resistance rate of P .aeruginosa to sulfamethoxazole/sulbactam was the high‐est of 100 .0% for 3 consecutive years .They were much sensitive to amikacin with the rate of 15 .1% -27 .8% . CONCLUSION The main sources of gram‐negative bacteria were E .coli , P .aeruginosa ,A .baumannii and K . pneumonia in clinic .With the severe situation of bacterial resistance ,we need to continue to closely monitor the trend of drug resistance of pathogenic bacteria in hospital and guide the antibiotic use .

关 键 词：革兰阴性菌 耐药性 临床用药 

分 类 号：R378[医药卫生—病原生物学]