目的：调查近3年我院住院和门诊患者的痰标本中分离的革兰阴性杆菌的菌群分布和耐药性。方法回顾性调查分析2008-2010年痰标本分离的革兰阴性菌株，所有菌株分离按《全国检验技术操作规程》第三版要求操作，采用 VITEK2 COMPACT 型全自动微生物分析仪进行细菌鉴定及药敏试验，并对结果进行统计分析。结果送检痰标本共21201份，检出致病菌8516株，检出率为40．17％，革兰阴性菌6345株，检出率为29．93％，其中肺炎克雷伯菌2198株，构成比为25．81％，大肠埃希菌1417株，构成比为16．64％，铜绿假单胞菌602株，构成比为7．07％。抗菌药物活性最高的是哌拉西林/他唑巴坦、丁胺卡那霉素（均达90％以上），碳青霉烯类、头孢替坦对大肠埃希菌、肺炎克雷伯菌敏感率均在90％以上，氨苄西林几乎对这三类细菌完全耐药，氨苄西林/舒巴坦、第一和第三代头胞菌素对大肠埃希菌、肺炎克雷伯菌敏感率较低；3年来 ESBLs 阳性率：大肠埃希菌分别为53．68％、49．09％、49．89％，肺炎克雷伯菌分别为49．19％、41．48％、38．80％。结论革兰阴性杆菌是深圳市儿童医院儿童痰标本分离的主要病原菌，其耐药情况并未出现较大的变迁，呈波动性变化。%Objective To investigate the changes of pathogen distribution and their drug-resistance of gram-negative bacteria in children’s sputum culture in Shenzhen Children’s Hospital in recent 3 years.Methods A retrospective study on clinical distribution from sputum sample.VITEK2 automicroscan system was used to identify the species and conduct drug resistance test.The data was analyzed by WHONET5.4 software.Results A total of 8516 strains were i-solated from sputum sample(21201),with Gram-negative bacteria 6345(29.93%).The antibiotic remaining the most active against all of the gram-negative bacteria was piperacillin/tazobactam,amikacin(>90%).The susceptibility rate of Escherichina coli,Klebsiella pneumoniae to carbopenems and cefotetan above 90%.The three bacteria were almost antimicrobial resistance to ampicillin.The susceptibility rate of Escherichina coli,Klebsiella pneumoniae to ampicillin/sulbactam,the first and the third generation cephalosporins were low.The rate of ESBLs-producing to Escherichina coli was 53.68%,49.09%,49.89%,and to Klebsiella pneumoniae was 49.19%,41.48%,38.80% in the recent 3 years. Conclusion The main pathogenic bacteria from sputum sample is gram-negative bacteria in Shenzhen Children’s Hos-pital,and the drug resistance hadn’t been obviously vicissitudes.
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