摘要
目的了解重症病房革兰阴性杆菌分布及耐药性特征。方法收集重症病房各类感染标本中分离的２００株革兰阴性杆菌分析及其分布，并采用浓度梯度法（Ｅｔｅｓｔ法）检测其耐药性。结果占前几位的革兰阴性杆菌为绿脓假单胞菌（２９．５％）、肺炎克雷伯菌（１９％）、大肠埃希菌和不动杆菌（各１４．５％）、阴沟杆菌（７．５％）等。头孢噻甲羧肟、环丙沙星、亚胺培能对绿脓假单胞菌的ＭＩＣ９０分别为８、３、６μｇ／ｍｌ。氨曲南、头孢氨噻肟、头孢噻甲羧肟对肺炎克雷伯菌和大肠埃希菌的最低抑菌浓度（ＭＩＣ）ＭＩＣ９０分别为３２～２５６μｇ／ｍｌ，６４～２５６μｇ／ｍｌ，有较高的耐药性。亚胺培能对阴沟杆菌的ＭＩＣ５０为１．５μｇ／ｍｌ，阴沟杆菌对其他抗生素耐药性较高。不动杆菌、嗜麦芽窄食单胞菌对所监测的抗生素广谱耐药。亚胺培能对不动杆菌的ＭＩＣ５０为０．７５μｇ／ｍｌ，耐药率为１０％。结论重症病房主要的革兰阴性杆菌均有较严重的耐药性，加强耐药性监测，合理使用抗生素十分重要。
Objective To investigate the outbreak and resistance of gram negative bacilli in intensive care units(ICUs).Methods 200 strains of gram negative bacilli were tested using etest.Results Among 200 strains of gram negative bacilli from ICUs in the period of July 1995 October 1996, 59(29.5%) Pseudomonas aeruginosa, 38(19%) Klebsiella pneumoniae, 29(14.5%)Escherichia coli and Acinetobacter, and 15(7.5%) Enterobacter cloacae were detected. MIC90 for ceftazidime, Ciprofloxacin, and Imipenem against Pseudomonas aeruginosa was 8,3 and 6 μg/ml, respectively. Klebsiella pneumoniae and Escherichia coli were poorly sensitive to aztreonam, cefotaxime, and ceftazidime. MIC50 for Imipenem against Enterobacter cloacae and Acinetobacter was 1.5 μg/ml and 0.75 μg/ml. Acinetobacter and Stenotrophomonas maltophilia were multi drug resistant to 12 drugs tested.Conclusion Most of gram negative bacilli in ICUs were seriously resistant. It is very important to select antibiotics correctly for infections of the patients in ICUs according to the results of susceptibility tests.
关键词
革兰阴性杆菌
耐药性
交叉感染
浓度梯度法
Gram negative bacilli Drug resistance, microbial Cross infection
