耐亚胺培南革兰阴性杆菌的临床分布及耐药性

目的：了解2007年1月～2009年12月我院老年患者亚胺培南耐药革兰阴性杆菌菌株的分离情况、临床分布及耐药性趋势.方法：收集该院2007年～2009年临床各类标本中分离到的245株耐亚胺培南革兰阴性杆菌,采用德灵Microscan微生物鉴定及药敏分析系统,对菌株进行鉴定及药敏试验.结果：2007年～2009年共分离到245株亚胺培南耐药株,其中非发酵菌科235株,占96%,以铜绿假单胞菌最多,占81.1%;其次为鲍曼不动杆菌,占15.6%,且鲍曼不动杆菌的亚胺培南耐药株呈逐年上升趋势,从2007年的5.8%上升至2009年的22.8%,而肠杆菌科亚胺培南耐药株仅占4%.耐亚胺培南的菌株对B内酰胺类生素耐药率为53.0%～100%,对喹诺酮类抗生素耐药率为60.2%～83.2%,对氨基糖苷类抗生素的耐药率相对较低,为28.2%～51.5%,其中以阿米卡星最为敏感.结论：亚胺培南对肠杆菌科具有非常强的体外抗茵活性,对非发酵菌科的体外抗菌活性较差.耐亚胺培南菌株大多存在多重耐药性,甚至泛耐药,临床应根据药敏试验的结果选用敏感的抗菌药物治疗.

Clinical distribution and antibiotic resistance of imipenem-resistant gramnegative rods

Objective： To investige the isolation, distribution and Imipenem resistence of Gram negative bacilli iso- lated from geriatric patients in our hospital from January 2007 to December 2009. Methods： Totally 245 Imipenem resistence of Gram negative bacilli were isolated from various specimens collected from 2007 to 2009 and the Microscan system was applied to bacterial identification and susceptibility testing Results： A total of 245 strains of Gram negative bacilli were isolated including 235 isolates of nonfermenters and 10 isolates of Enterobaeteriaceae , accounted for 96% and 4%, respectively. The most predominant pathogens were Pseudomonas aeruginosa and Acinetobacter baumannii , and the resistant rates of Acinetobacter baumannii to Imipenem increased gradual- ly . Imipenem resistence of Gram negative bacilli showed highest resistance rate to 131actam antibiotics （ 53.0~ 100%） , and lowest resistance rate to aminoglycosides （28.2-51.5%）. Conclusions： Imipenem had high antimicrobial activity to Enterobacteriaceae , but not to nonfermenters . Imipenem resistant strains were mostly multidrug resistant , even pandrug resistant . Different antimicrobial therapy should be adopted according to the results of susceptibility tests