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目的了解我院近5年革兰氏阴性杆菌的分布及耐药状况,为临床合理用药提供科学依据。方法回顾性分析2010年1月—2014年12月本院临床分离的3 248株革兰氏阴性杆菌。采用纸片扩散法和最低抑菌浓度进行药物敏感性实验,结果判定参照2012年临床和实验室标准化协会(clinical and laboratory standards institute,CLSI)标准。结果临床分离的革兰氏阴性杆菌呈逐年上升趋势,其中以鲍曼不动杆菌、肺炎克雷伯杆菌、铜绿假单胞菌、大肠埃希菌、产酸克雷伯菌最为常见。肠杆菌科细菌对常用抗生素耐药率变化趋势不明显,大肠埃希菌对抗生素的耐药率普遍高于肺炎克雷伯菌和阴沟肠杆菌。肠杆菌科细菌对碳青霉烯类保持较高的敏感性,对亚胺培南和美罗培南耐药率均较低。大肠埃希菌对氨苄西林、氨苄西林/舒巴坦、哌拉西林、头孢唑林、头孢呋辛、庆大霉素、环丙沙星、左氧氟沙星、复方新诺明耐药率均较高。除鲍曼不动杆菌对氨苄西林耐药率逐年上升外,非发酵菌对常用抗生素耐药率变化较平稳。除阿米卡星外,鲍曼不动杆菌对常用抗生素有较高抗性。铜绿假单胞杆菌对氨苄西林、氨苄西林/舒巴坦、复方新诺明耐药率较高。嗜麦芽窄食单胞菌对左氧氟沙星、米诺环素及复方新诺明耐药率较低。结论我院革兰氏阴性杆菌对常用抗菌药物耐药性较高,应合理应用抗菌药物。
Objective To understand the distribution and drug resistance of Gram-negative bacilli in our hospital in recent 5 years and to provide a scientific basis for clinical rational drug use. Methods A retrospective analysis of 3 248 Gram-negative bacilli clinically isolated from January 2010 to December 2014 in our hospital was performed. Drug susceptibility testing was performed using disk diffusion and minimal inhibitory concentrations. The results were determined by reference to the 2012 CLSI (Clinical and Laboratory Standards Institute) standard. Results The clinical isolates of Gram-negative bacilli showed an upward trend year by year, of which Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Klebsiella oxytoca were most common. Enterobacteriaceae commonly used antibiotics resistance rate trend is not obvious, Escherichia coli antibiotic resistance rates are generally higher than Klebsiella pneumoniae and Enterobacter cloacae. Enterobacteriaceae carbapenems to maintain a high sensitivity, resistance to imipenem and meropenem are low. Escherichia coli ampicillin, ampicillin / sulbactam, piperacillin, cefazolin, cefuroxime, gentamicin, ciprofloxacin, levofloxacin, cotrimoxazole resistance rates were higher. In addition to Acinetobacter baumannii resistance rate of ampicillin increased year by year, non-fermentative bacteria commonly used antibiotic resistance rate changes more smoothly. In addition to amikacin, Acinetobacter baumannii has higher resistance to commonly used antibiotics. Pseudomonas aeruginosa ampicillin, ampicillin / sulbactam, cotrimoxazole resistance rate higher. Stenotrophomonas maltophilia low resistance to levofloxacin, minocycline and cotrimoxazole. Conclusion Gram-negative bacilli in our hospital have higher resistance to commonly used antimicrobial agents. Antibiotics should be applied reasonably.