摘要
目的:研究临床常见革兰阴性杆菌的临床分布及对三种碳青霉烯类抗菌药物(亚胺培南、美罗培南和厄他培南)的耐药性,为碳青霉烯类抗菌药物用于治疗阴性杆菌引起的临床感染提供依据。方法:对2014年1月?2017年12月本院住院及门诊患者临床感染标本进行病原菌培养,采用VITEK-2 Compact系统进行细菌菌种鉴定、药物敏感性试验,数据统计分析采用WHONET5.5软件。结果:共分离到10676株辜兰阴性杆菌,肠杆菌科7383株,占69.16%,非发酵菌3277株,占30.70%。分离率前5位的肠杆菌科细菌和前5位的非发酵菌共9803株,占革兰阴性杆菌总数的91.82%。菌株主要来源于痰、创口分泌物/组织、尿液和血液等临床标本。在3467株大肠埃希菌和2238株肺炎克雷伯菌中分别分离到耐碳青霉烯类菌株34株(占0.98%, 34/3467)和302株(占13.49%,302/2238)。碳青霉烯类耐药的肠杆菌对临床常见的13种抗菌药物的耐药率明显高于碳青霉烯类敏感菌株,差异具有统计学意义(P<0.05)。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为51.48%和51.21%,鲍曼不动杆菌对此二种抗菌药物的耐药率超过75%。结论:我院革兰阴性杆菌以肠杆菌科细菌为主;碳青霉烯类抗菌药物对肠杆菌科细菌有很好的治疗作用,但某些菌株已有较高的耐药性发生;非发酵菌(铜绿假单胞菌和鲍曼不动杆菌,尤其是鲍曼不动杆菌)对碳青霉烯类抗菌药物耐药率居高不下;临床应加强病原菌耐药性及产酶菌株的监测,避免不合理应用抗菌药物而造成耐药菌株的产生与传播。
Objective: This study aim to investigate the clinical distribution of common gram-negative bacilli and the resistance to three carbapenem antibiotics (Imipenem, Meropenem and Ertapenem), and to provide the basis for the treatment of clinical infections caused by gram -negative bacilli with carbapenem antibiotics. Methods: Pathogenic bacteria which were isolated from clinical infection specimens of hospitalized and outpatients in our hospital from January 2014 to December 2017 were analyzed retrospectively. VITEK-2 Compact system was used for bacterial identification and drug susceptibility test The data were analyzed by WHONET5.5 software. Results: A total of 10676 strains of Gram -negative bacilli were isolated, including 7383 ( accounting for 69.16%) strains of Enterobacteriaceae and 3277 (accounting for 30.70%) strains of non -fermentative bacteria. The top 5 species of Enterobacteriaceae and the top 5 non fennentative bacteria were 9803 strains, accounting for 91.82% of the total gram-negative bacilli. The strains were mainly isolated from sputum, wound secretion / tissue, urine and blood. 34 strains (0.98%, 34/3467) of carbapenem resistant bacteria were isolated from 3467 strains of Escherichia coli, and 302 strains (13.49%, 302/2238) from 2238 strains of Klebsiella pneumoniae. The resistance rates of carbapenem resistant Enterobacteriaceae to clinical common 13 antimicrobial agents were significantly higher than those of carbapenem sensitive strains, and the difference were statistically significant (P<0.05). The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 51.48% and 5121%, and the resistance rates of Acinetobacter baumannii on these two antimicrobials were more than 75%. Conclusion: Gram -negative bacillus are mainly enterobacteria in our hospitaL Carbapenem antibiotics are effective in the treatment of infections caused by Enterobacteriaceae strains, however, relative high resistance rates have been detected in some isolates. Non - fermentative bacteria ( Pseudomonas aeruginosa and Acinetobacter baumannii, espedaily the latter) have high resistance rates to carbapenem antibiotics. It is necessary to strengthen drug resistance of pathogen and enzyme producing strain monitoring, and to avoid the generation and spreading of drug-resistant strains due to irrational use of antibiotics.
作者
刘春林
陈弟
徐红云
张唤
马众仙
谭光剑
邓德耀
LIU Chun-lin;CHEN Di;XU Hong-yun(Department of Laboratory, the second hospital of Yunnan Province(the first affiliated hospital of Yunnan University), Yunnan Kunming 650021)
出处
《医学检验与临床》
2019年第4期19-23,共5页
Medical Laboratory Science and Clinics
