摘要:
目的 了解中国云南地区血流感染革兰阴性杆菌的构成及耐药性.方法 收集2012年1月至2014年12月卫生部全国细菌耐药监测网云南地区28家医院血流感染的革兰阴性杆菌,各医院按统一的方法进行细菌培养、分离、鉴定和药敏试验.统计分析采用WHONET软件进行.结果 共分离非重复的革兰阴性杆菌9 042株,其中肠杆菌科占82.4%,非发酵菌占17.6%。肠杆菌科以大肠埃希菌和肺炎克雷伯菌为主;非发酵菌以鲍曼不动杆菌和铜绿假单胞菌为主.大肠埃希氏菌49.29%、肺炎克雷伯菌13.17%、鲍曼不动杆菌4.04%和铜绿假单胞菌3.85%;肠杆菌科细菌对一代头孢菌素类敏感率低于60%,大肠埃希菌和肺炎克雷伯菌对亚胺培南的敏感率均近100%,阿米卡星的敏感率大于85%,哌拉西林/他唑巴坦的敏感率大于70%,头孢吡肟的敏感率大于70%.肺炎克雷伯菌对亚胺培南和阿米卡星的敏感率呈下降趋势.非发酵菌对常用抗菌药敏感率明显低于肠杆菌科细菌.铜绿假单胞菌的敏感率为妥布霉素85%、环丙沙星71.7%、阿米卡星82.9%、哌拉西林/他唑巴坦75.3%、哌拉西林59.6%.鲍曼不动杆菌耐药情况更为严重,对三代、四代头孢菌素敏感率小于30%,对氨苄西林/舒巴坦、哌拉西林/他唑巴坦、喹诺酮类和碳青霉烯类的敏感率均小于40%.结论 血流感染革兰阴性杆菌中大肠埃希菌分离率最高大.非发酵菌对常用抗菌药物耐药率明显高于肠杆菌科,耐药现状严峻.
Abstract:
Objective To learn the species distrilbution and drug-resistance of Gram-negative bacilli among bloodstream infections(BSI) in Yunnan province of China during 2012 to 2014.Methods Bloodstream infected Gram-negative bacilli were collected from 28 general hospitals in Yunan province of China.Data from all hospitals were applied with the same method of bacteria culture,iso1 ation,identification and antibiotic sensitivity tests.WHONET 5.6 was used to perform the statistical analysis.Results A total of 9042 clinical strains of non-repetitive gram-negative bacilli were collected.Enterobacteriaceae and Non-fermenter bacteria accounted for82.4% and 17.6% respectively.Enterobacteriaceae were mainly composed of Escherichia coli and Klebsiella pneumoniae.Non-fermenter bacteria were mainly composed of Acinetobacter baumannii and Pseudomonas aerouginosa.Escherichia coli accounted for the majority 49.29%, other species were Klebsiella pneumoniae13.17%, Acinetobacter baumannii 4.04% and Pseudomonas aeroginosa 3.85%.The susceptible rate of Enterobacteriaceae strains to the first generation cephalosporin was lower than 60%.The susceptible rate of E coliand Klebsiella pneumoniae to impenem was close to 100%, to Amikacin was more than 85%, to piperacillin-tazobactam was more than 70%, to Cefepime was more than 70%.But the susceptible rate of Klebsiella pneumoniae to impnem and amikacin decreased year by year from 2012 to 2014.The susceptible rate of Enterobacter cloacae to Amikacin was 86.4%~93.6%, Ciprofloxacin 70.5~76%,Cefepime 72.1~82.8%.It was less than other Enterobacteriaceae.The susceptible rate of Non-fermenter bacteria to normal antibiotics was much lower than Enterobacteriaceae.The susceptible rates of Pseudomonas aeroginosa to Impnem was 58.9%,Tobramycin 85%,Ciprofloxacin 71.7%,Amikacin 82.9%,Piperacillintazobactam 75.3%,Piperacillin59.6%,Atreonam 46.5%, Ceftazidime 69.1% and Cefepime 68.9% respectively.Furthermore, Acinetobacter baumannii's durg-resistance was more severe.The susceptible rate of Acinetobacter baumannii was lower than30%, to the third and fourth generation cephalosporin, the susceptible rate of Ampicillin/Sulbactam,Cefoperazone/Sulbactam, Carbapenems, Piperacillin/Tazuobatan, Quinolones and Carbapenems was less than40%.Conclusion Gram-negative bacilli have low susceptibilities among BSI.E.coli is the most common pathegon among BSI.The resistant rate of Non-fermenter bacteria to normal antibiotics is severe in hospitals.
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