2011～2015年医院呼吸内科常见革兰阴性菌耐药性分析与临床用药探讨

目的：分析2011～2015年我院呼吸内科常见革兰阴性菌的分布情况及耐药性特点，为规范抗生素的合理使用提供依据。方法选用法国梅里埃公司生产的ID 32GD试剂盒，应用ATB Expression全自动分析系统对细菌进行鉴定与药敏试验。结果2011～2015年在我院呼吸内科常见的病原菌分别为肺炎克雷伯菌（31．0％）、大肠埃希菌（21．2％）、铜绿假单胞菌（23．2％）与鲍曼不动杆菌（14．8％）。肺炎克雷伯菌对碳青霉烯类的耐药率几乎为0，对单纯的头孢菌素耐药率相对较高，但对含β‐内酰胺酶抑制剂的头孢菌素类以及阿米卡星有较强的抗菌活性；大肠埃希菌对哌拉西林耐药率高，但对含酶青霉素类有较强的抗菌活性，对碳青霉烯类的耐药率连续5年来均为零；铜绿假单胞菌对磺胺类耐药性较高，对头孢三代、头孢四代及含酶青霉素类与含酶头孢类均有较强的抗菌活性，但敏感性呈逐年下降趋势；鲍曼不动杆菌的耐药率呈逐年上升趋势，仅对含酶的头孢哌酮／舒巴坦敏感（约80％）。结论医院呼吸内科革兰阴性菌仍以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌为主。鲍曼不动杆菌耐药性逐年增长的问题已日趋严重，相关部门应定期监测细菌耐药趋势，指导临床合理用药，特别是合理应用抗生素以避免细菌耐药及减少细菌耐药性的发生。

The characteristics of drug resistance and clinical medication of Gram-negative bacteria in hospital during 2011~2015

Objective To analyze the distribution and drug resistance of gram negative bacteria in the respiratory department of our hospital during 2011~2015 ,and to provide the help for clinical treatment . Methods The ID 32GD kit produced by French bioMerieux ATB ,Expression automatic analysis system for identification and drug sensitivity test of bacteria . Results 2011~2015 years in the Department of respiratory infection in our hospital collected a total of 999 strains of gram negative bacteria ,the most common pathogens were Klebsiella pneumoniae , accounting for 31% ,followed by Escherichia coli ,accounting for 21 .2% ,again were Pseudomonas aeruginosa and Acinetobacter Bauman ,the the ratio were 23 .2% and 14 .8% .Klebsiella pneumoniae resistant to carbopenems rate is almost zero ,the relatively high rate of cephalosporin resistant herpes ,but of cephalosporin containing beta lacta‐mase inhibitors will maintain strong antibacterial activity ,Amikacin also maintained a strong antibacterial activity . Escherichia coli resistant to piperacillin rate is very high ,but has strong antibacterial activity of enzyme containing penicillins ,quinolones and sulfonamides were higher on the resistance rate ,low rate of resistance to Amikacin ,re‐sistance to carbapenems was very low ,for 5 consecutive years ,the resistance rate to zero .Pseudomonas aeruginosa of sulfonamides has almost no effect ,the three generation ,four generation of cephalosporin and enzyme containing penicillins and cephalosporins containing enzymes have strong antibacterial activity of aminoglycosides can maintain high antibacterial activity ,maintain a high activity is no exception to carbapenems ,but the sensitivity is decreased year by year .Bauman Acinetobacter resistance rate is increasing year by year ,in addition to enzyme containing Cef‐operazone/Shubatan is about 20% ,especially aztreonam ,drug resistance rate for three consecutive years up to 100% ,even resistant to carbapenems was as high as 78 .6% . Conclusion Hospital Department of respiratory medicine gram negative bacteria are still Klebsiella pneumoniae ,Escherichia coli ,Pseudomonas aeruginosa ,Acineto‐bacter Bauman dominated .In clinical work ,we need to guard against the growth of drug resistance of Acinetobacter Bauman ,we should regularly monitor the trend of bacterial drug resistance ,rational use of antibiotics in order to re‐duce the occurrence of bacterial drug resistance .