临床常见革兰氏阴性杆菌的分布及耐药性分析  

A clinical analysis of the distribution and drug resistance of Gram negative bacilli

作　　者：季萍[1] 张琼[1] 道彩梅[1] 朱震宏[1] 高小妹[1] 

机构地区：[1]新疆医科大学第一附属医院检验科,新疆乌鲁木齐830054

出　　处：《新疆医科大学学报》2002年第3期318-320,共3页Journal of Xinjiang Medical University

摘　　要：目的:了解临床常见革兰氏阴性杆菌分离及分布情况和超广谱 β-内酰胺酶菌株的耐药特点 ,指导临床合理用药。方法 :采用 VITEK- AMS微生物自动分析仪和药敏卡进行药敏及 ESBL s检测。结果 :革兰氏阴性杆菌检出率为 6 3.5 % ,主要菌群分布依次为大肠埃希菌、铜绿假单胞菌、不动杆菌属、肠杆菌属、肺炎克雷伯菌。肠杆菌科细菌对氨苄西林耐药率为 80 %～ 10 0 % ,除肺炎克雷伯菌外 ,对阿莫西林 /棒酸耐药率为 >6 0 %。除大肠杆菌外 ,对培氟沙星耐药率为 <5 0 %。除肠杆菌属外对奈替米星、头孢西丁的耐药率为 15 %～ 30 % ,铜绿假单胞菌对亚胺培南、庆大霉素、头孢他啶、妥布霉素耐药率为 10 %～ 2 5 %。不动杆菌属对亚胺培南、妥布霉素耐药率 2 %～2 9%。产 ESBL s菌株高耐三代头孢菌素 ,对氨基糖苷类、复方新诺明、喹诺酮类交叉耐药率高达 78.9%～ 10 0 %。结论 :大肠埃希菌引起再发性尿路感染首选呋喃妥因。对非产 ESBL s株除阴沟肠杆菌和产气肠杆菌应首选奈替米星、头孢西丁及三代头孢。对多重耐药菌株铜绿假单胞菌和鲍曼不动杆菌应根据药敏结果合理选用抗生素。对产ESBL s菌株的治疗 。Objective: To guide the clinical drug use by studying the distribution of Gram negative bacilli in Urumqi and the drug resistance of extended spectrum β lactamase strains(ESBLs). Methods: To test the species with GNI\++ of microbe automatic analyser and drug sensitivity and ESBLs with drug sensitivity card GNS/506. Results: The testing rate of Gram negative bacilli was 63.5%, and the major florae of bacteria were Escherichia coli (17.9%), Pseudomaonas aeruginosa (14.7%), Acinetobacter(12.9%), Enterobacter(12.9%), Klebsiella pneumoniae(9.7%). The drug resistance indicated that the resistant rate of Enterobacterri acaae bacterium to ampicillin was 80%~100%, the rate of the other bacteria to amocillin was >60% except Enterobacter. The rate to pefloxacin was <50% except Escherichia coli. The rate to netilmicin and cefoxitin was 15%~30% except Enterobacter. The rate of Pseudomaonas aeruginosa to imipenem, gentamicin, ceftazidime and tobramycin was 10%~25%. The rate of Acinetobacter to imipenem and tobramycin was 2%~29%. The rate of ESBLs to cephalosporin(Ⅰ,Ⅱ,Ⅲ) was much higher, and the rate to aminoglycoside, sulfamethoxazole, and quinovic ketone was 78.9%~100%. Conclusion: The secondary urethral infection caused by Escherichia coli should be treated with nitrofurantoin first. Netilmicin, cefoxitin and cephalosporin(Ⅲ) should be used in the bacteria without producing ESBLs(except Enterobacter cloacae and Enterobacter aerogenes). To multiresistant strains, Pseudomaonas aeruginosa and Acinetobacter baumannu, the antibiotics should be used according to the drug sensitivity result. Imipenem was the best to the strains with ESBLs.

关 键 词：革兰氏阴性杆菌 耐药性 超广谱Β-内酰胺酶 细菌学检测 

分 类 号：R378[医药卫生—病原生物学] R446.5[医药卫生—基础医学]