目的 分析医院2008年和2009年临床分离的革兰阴性菌分布及耐药性变迁,为临床合理使用抗菌药物提供参考.方法从临床送检标本中分离出病原菌,用自动细菌鉴定及药敏测定仪进行耐药性监测.结果该院2008年分离病原菌5 886株,其中革兰阴性菌3 420株(58.10%),列前5位的分别是大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、阴沟肠杆菌及流感嗜血杆菌.2009年分离病原菌5 238株,其中革兰阴性菌3 221株(61.49%),列前5位的依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌及鲍曼不动杆菌.碳青霉烯类仍是对革兰阴性杆菌(嗜麦芽窄食单胞菌除外)抗菌作用最强的一类抗生素.结论该院临床分离病原菌以革兰阴性菌为主,尤以大肠埃希菌常见.致病菌耐药问题严重,及时监测感染致病菌的变迁和耐药发展趋势对指导临床用药至关重要.%Objective To investigate the change of distribution and drug resistance of Gram- negative bacteria in our hospital from 2008 to 2009 to provide reference for the rational antibacterials use in clinic. Methods The pathogenic bacteria isolated from clinical samples were collected and performed the surveillance of drug resistance by using automatic micro- organisms identification and drug detection susceptibility instrument. Results 5 886 strains of pathogens were isolated during 2008 in our hospital. Among them, 3420 strains were Gram- negative bacteria accounting for 58. 10％ and the top five were Escherichia coli(ECO), Paeudomonas aeruginosa(PAE), Klebsiella pneumoniae ss. ozaenae(KOZ), Enterobacter cloace (ECL) and Haemophilus haemolyticus(HIN). During 2009, 5 238 strains of pathogens were isolated in our hospital. Among them, 3 221 strains were Gram-negative bacteria accounting for 61.49％, the top five were ECO, KOZ, PAE, ECL and Acinetobacter baumannii (ABA). Carbapenems were the most active antibiotics against Gram negative bacilli(except Stenotrophomonas maltophilia). Conclusion Most clinically isolated pathogenic bacteria are Gram-negative in our hospital. Among them, Escherichia coli and multi-resistant strains are most common. The drug resistance of pathogenic bacteria is serious. Timely monitoring the change of infected pathogen distribution and the developing trend of drug resistance is most important to guide the clinical drug use.
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