儿童重症监护病房革兰阴性菌的分布与耐药性分析

目的了解儿童重症监护病房(ICU)革兰阴性菌对临床常用抗菌药物的耐药性变化,指导临床合理选用抗菌药物。方法采用纸片扩散法对2007年1月至12月本院ICU分离出的革兰阴性菌进行药物敏感性检测,按照CLSI2006年版标准判断结果。结果共分离出262株革兰阴性菌,其中以肺炎克雷伯菌(27.1%)、大肠埃希菌(23.3%)、铜绿假单胞菌(20.2%)、鲍曼不动杆菌(11.1%)为主。肺炎克雷伯菌和大肠埃希菌超广谱β内酰胺酶(ESBL)(+)分别占87.3%和73.8%。肺炎克雷伯菌、大肠埃希菌和鲍曼不动杆菌对亚胺培南最敏感(100%)。铜绿假单胞菌对环丙沙星有较高的敏感。结论亚胺培南对革兰阴性菌具有较好的抗菌活性,根据病原菌的种类及药物敏感性结果合理使用抗菌药物,是有效控制患儿感染和减少耐药菌株产生的重要手段。

Distribution and analysis of drug resistance of Gram-negative bacteria in the children's intensive care unit

Objective To investigate the changes of drug resistance about Gram-negative bacteria on clinical antimicrobial in the children＇s intensive care unit（ICU） ,and to guide the selection of antibiotics in clinic. Methods Antimicrobial susceptibility testing were done on Gram-negative bacteria which isolated from ICU in our hospital by Kirby-Bauer method from January to December 2007, according to the standard of CLSI 2006 edition to judge the results. Results All of 262 Gram-negative bacteria were isolated, the main strains were pneumoniae Klebsiella（ 27. 1% ）, Escherichia coli （23.3%）, Pseudomonas aeruginosa （20. 2% ） and Acinetobacter baumannii （ 11. 1% ）. Escherichia coli and Klebsiella pneumoniae ESBL（ ＋ ）, was 87.3% and 73.8% respectively. The susceptibility rate of Klebsiella pneumoniae, Escherichia coli and acinetobacter baumannii to imipenem was the highest（ 100% ）. The degree of sensitivity of pseudomonas aeruginosa to ciprofloxacin was higher. Conclusion Imipenem against gram-negative bacteria has a good antibacterial activity. Using the antibiotics reasonably according to the type of pathogenic bacteria and the result of drug sensitivity is effective on children infection ,and this is an important tool to reduce the form of drug-resistant strains.