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1、130中国感染与化疗杂志!""$年&月#’日第$卷第!期ChinJInfectChemother，Apr.!""$，Vol.$，No.!·实验研究·重症监护病房革兰阴性杆菌耐药性监测与分析葛庆岗#,阴"宏!,孙丕东(,汪宗昱#,李宏亮#摘要:目的了解重症监护病房(ICU)革兰阴性杆菌对临床常用抗菌药的耐药性变化,以指导合理选择抗菌药物。方法采用纸片扩散法对!""(年#月+!""&年#!月我院ICU分离出的革兰阴性杆菌进行药敏检测,按NCCLS!""(年版标准判断结果。结果!年中分离出!&’株革兰阴性杆菌,其中以不动杆菌(&%.!%)和铜
2、绿假单胞(##."%)为主的非发酵菌占$’/(%,*&.’%来自痰液标本。亚胺培南的总敏感率最高()(.)%),对除嗜麦芽窄食单胞菌外的其他革兰阴性杆菌具有很好的抗菌活性;革兰阴性杆菌对头孢他啶、头孢哌酮-舒巴坦、头孢吡肟、哌拉西林-三唑巴坦和阿米卡星的敏感率多数为&&%～$%%,对其他抗菌药高度耐药;头孢他啶和复方磺胺甲噁唑对嗜麦芽窄食单胞菌的敏感率高达*(.(%。大肠埃希菌和肺炎克雷伯菌产ESBLs菌株分别占!$.(%和(!.(%;产酶菌株对多数常用抗菌药物耐药率高于非产酶菌株,对亚胺培南无耐药,头孢哌酮-舒巴坦和哌拉西林-三唑巴坦
3、对产ESBLs菌株抗菌活性明显强于其他头孢菌素。结论非发酵菌在从ICU分离出的革兰阴性杆菌中占有较高比例,亚胺培南对除嗜麦芽窄食单胞菌外的其他革兰阴性杆菌具有较好的抗菌活性,其他抗菌药物抗菌活性较低。关键词:重症监护病房;革兰阴性杆菌;耐药性中图分类号:R(*%/!文献标识码:B文章编号:#"")-**"%(!""$)"!-"#("-"&Surveillanceofantimicrobialresistanceamonggram-negativebacillifromintensivecareunitGEQing-gang,YINZhe
4、n-hong,SUNPi-dong,WANGZong-yu,LIHong-liang.(IntensiveCareU-nit,PekingUniversityThirdHospital,Beijing#"""%(,China)Abstract:ObjectiveToinvestigatetheantimicrobialresistanceamonggram-negativebacillifromintensivecareunit(ICU)forrationaluseofantimicrobials.MethodsFromJanuary!
5、""(toDecember!""&,antimicrobialsusceptibilitytestingwasdoneongram-negativebacilliisolatedfromICUinourhospitalbyKirby-Bauermethod.TheresultswereinterpretedaccordingtoNC-CLS!""(.ResultsOutof!&’isolates,$’.(%werenon-fermentativebacilli(Acinetobacterspp.&%.!%andPseudomonasae
6、ruginosa##."%).About*&.’%ofthestrainswereisolatedfromsputum.Thesusceptibilityrateofgram-negativebacillitoimipenemwasthehighest()(.)%).Imipenemshowedgoodantimicrobialactivityagainstgram-negativebacilliexceptStenotrophomonasmaltophilia.Thesusceptibilityrateofgram-negativeb
7、acillitoceftazidime,cefoperazone-sulbactam,cefepime,amikacinandpiperacillin-tazobactamrangedfrom&&%to$%%,buttheywerehighlyresistanttootherantimicrobialagents.ThesusceptibilityratesofS.maltophiliatoceftazidimeandTMP-SMZwere*(.(%.About!$.(%ofE.coliand(!.(%ofKlebsiellaspp.i
8、solateswereextended-spectrumβ-lactamases(ESBLs)producers.TheresistancerateofESBLpro-ducingstrainstomost
