医院内4种主要革兰阴性菌分布及耐药率分析

摘要：目的 分析大连某三甲医院4种主要革兰阴性病原菌的分布及细菌耐药性变迁，为抗菌药物的合理使用提供依据。方法 回顾性分析2012?2015年住院患者中分离的4种革兰阴性菌临床分布及每年的耐药率，利用WHONET 5.6软件进行统计分析。结果 4年分离致病菌28 485株，其中大肠埃希菌2 994株，肺炎克雷伯菌1 375株，鲍曼不动杆菌1 079株，铜绿假单胞菌1 998株，共占分离致病菌总数的26.1%。4种菌对哌拉西林的耐药率最高（37.2%~78.2%），对头孢哌酮/苏巴坦耐药率最低（6.7%~39.1%）。2012?2015年，大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌的抗生素耐药率有下降趋势，鲍曼不动杆菌对多数抗生素耐药率都高，且逐年上升。结论 本院4年感染中4种主要革兰阴性菌占主导地位。4种菌对不同抗生素耐药率和变化不同，鲍曼不动杆菌耐药最严重。4种菌对于头孢哌酮/苏巴坦均比较敏感，对哌拉西林耐药严重。在临床治疗中应有针对性加强管理和用药。

Distribution and drug resistance of 4 main Gram negative bacteria in hospital

Abstract: Objective To investigate the distribution and drug resistance of 4 Gram negative pathogenic bacteria in a 3A class hospital in Dalian, and provide evidence for rational use of antimicrobial drugs. Methods Statistical analysis was performed using WHONET 5.6 software. The drug resistance rate and clinical distribution of 4 Gram negative bacteria isolated from inpatients in our hospital during 2012 and 2015 were retrospectively analyzed. Results Among the total 28 485 strains of pathogenic bacteria isolated during the four years, there were 2 994 strains of Escherichia coli, 1 375 strains of Klebsiella pneumoniae, 1 079 strains of Acinetobacter baumannii, and 1 998 strains of Pseudomonas aeruginosa, accounting for 26.1% together. The resistance rates of the four pathogens to Piperacillin were the highest (37.2% - 78.2%), while those to Cefoperazone/Sulbactam were the lowest (6.7% - 39.1%). The antibiotic resistance of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa showed a downward trend during the four years, while that of Acinetobacter baumannii was high and increased year by year. Conclusion The four Gram-negative bacteria are dominant in our hospital, and show different resistance to antibiotics, among which Acinetobacter baumannii is the most resistant. They are sensitive to Cefoperazone/Sulbactam while highly resistant to piperacillin.