目的：以了解医院感染革兰阴性菌的临床分布及耐药特点，为临床抗菌药物的应用提供依据。方法对2010年~2012年我院常见的医院感染革兰阴性菌的临床分布及耐药性进行回顾性分析。结果在医院感染细菌前5位的革兰阴性菌为大肠埃氏菌、肺炎克雷伯氏菌、铜绿假单胞菌、鲍氏不动杆菌、奇异变形杆菌、其次是产气肠杆菌、阴沟肠杆菌、食麦芽假单胞菌。细菌均呈现多耐药趋势，临床常用的第一、二、三代头孢菌素类、单环内酰胺类、头霉素类、部分β-内酰胺酶抑制剂由于细菌产ESBLs及AmpC而发生耐药，第四代头孢吡肟耐药率也达50%~60%，耐碳青霉烯类鲍氏不动杆菌由于碳青霉烯类抗菌药物的使用强度增加而显著增加，我院美罗培南、亚胺培南耐药率逐年明显上升已接近60%。而氨基糖苷类中的阿米卡星除鲍曼氏不动杆菌外由于近期少用使敏感性有所提高。结论分析医院感染常见感染细菌分布及耐药性，对指导临床合理应用抗菌药物及预防和控制耐药菌在医院内传播有着重要意义。%Objective To investigate the clinical distribution and drug resistance of gram-negative bacteria in nosoconmial infections and to proved the reference for reasonable use of the antibiotics.Methods The clinical distribution and drug resistance of gram-negative bacteria in nosoconmial infections from 2010 to 2012 were analysis by the means of retrospective survey.Results The top ifve were Escherichia coli, Klebsiella spp, Pseudomonas aeruginosa, Acinetobacter baumanii and Proteus mirabilis. The behind three were Enterobacter aerogenes, Enterbacter cloacae, Stenotrophomonas maltophilia. The gram-negative bacteria in nosoconmial infections were multidrug resistance to antibiotics. The 1, 2, 3 generation of cephalosporin, single ring lactam, Cephamycins antibiotics and part β-lactamase inhibitor were resistance to antibiotics because ESBLs and AmpC producing bacteria. The fourth generation cephalosporin cefepime resistance rate reached 50%-60%. The meropenem, imipenem resistant rate increased year by year close to 60%. And the sensitivity of Amikacin in addition to Acinetobacter baumanii in Acinetobacters increased because the recent use less.Conclusion To understand theclinical distribution and drug resistance of gram-negative bacteria in nosoconmial infections can guide reasonable use of the antibiotics as well as the prevention and control of drug-resistant bacteria in nosocomial transmission.
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