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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。
Objective To analyze the distribution of four major gram-negative pathogens and the change of bacterial resistance in a top-three hospital in Dalian, and provide evidence for the rational use of antibacterials. Methods The clinical distribution and annual drug resistance of 4 Gram-negative bacteria isolated from hospitalized patients from 2012 to 2015 were retrospectively analyzed. The data were analyzed by WHONET 5.6 software. Results 28 485 strains of pathogens were isolated in 4 years, including 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, 26.1% of the total number of pathogens. Four strains had the highest resistance to piperacillin (37.2% -78.2%) and the lowest (6.7% -39.1%) to cefoperazone / subbatidin. The antibiotic resistance rates of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa decreased from 2012 to 2015. Acinetobacter baumannii had a high rate of resistance to most antibiotics and increased year by year. Conclusions Four major Gram-negative bacteria dominated the four-year infection in our hospital. Four strains of different antibiotic resistance rates and changes in different Acinetobacter baumannii resistance is the most serious. The four kinds of bacteria were more sensitive to cefoperazone / subbatian and had a serious resistance to piperacillin. In clinical treatment should be targeted to strengthen management and medication.