| In early 1928, Penicillin was discovered by the British medical scientist Fleming,Since then, the infectious diseases without antimicrobial treatment era ended forever.With the development of the times,various antimicrobial were rapidly developed and widely used in various types of infectious diseases treatment, and played a positive role, which effectively controled the diseases, prolonged the life of patients and improved the quality of life of patients.However, bacterial resistance brings a new difficult problem to clinical treatment. Especially gram-negative bacillus drug resistance problem has become a concern of the whole society as a public health problem..At present, the whole world is carrying out a variety of sizes of the bacterial resistance surveillance work. For example, the United States is to establish a national nosocomial infection surveillance system ( NNIS ), the world more than 30 countries involved in the SENTRY antibacterial drug monitoring project, Europe has established the European bacterial resistance surveillance system ( EARSS ), etc.. China has also done a variety of sizes of the bacterial resistance surveillance work, such as the national antimicrobial resistance monitoring network ( Mohnarin ), the bacterial isolates resistant to Etest and agar dilution method in monitoring ( SEANIR ), Chinese CHINET bacterial resistance monitoring etc..Due to that application of antimicrobial agents have different habits in the different areas,the bacterial resistance and development are also different. The data shows that in different countries, different regions, different hospitals, the different sections of the same hospital, the bacterial drug resistance rates also were different. Therefore, understanding of bacterial distribution and drug resistance monitoring results guides clinicians in our region and units to correctly use antimicrobial drugs,which is very important to reduce and delay the emergence of resistant strains and effectively control the prevalence of resistant strains. Understanding the distribution and resistance situation of clinical isolates of gram-negative bacilli in our hospital from2009 to 2010, provides the basis for clinical rationally use of antimicrobial agents, and this study collected 1171 clinical isolates of gram-negative bacilli from 2009 January to 2010 December ( excluding separations of the repeated strain from the same patient or the same parts ). The use of French bioMerieux API identification system and Vitek-compact identification system for bacteria identification was made. Drug sensitivity test used disc diffusion method (Kirby-bauer method) according to CLSI M100 rules as the standard interpretation of results.The statistical results were analyzed by WHONET5.3 software and SPSS13.0 statistical software.The results showed that 1171 isolates of gram-negative bacilli were separated from January 2009 to December 2010, of which 689 strains were separated in 2009 and the top five of the pathogenic bacteria were Klebsiella, Acinetobacter Baumannii, Pseudomonas aeruginosa, Enterobacter cloacae, Escherichia coli; and 482 strains of the Gram-negative bacteria were separated in 2010 and the top five of the pathogenic bacteria were Klebsiella, Acinetobacter Baumannii, Pseudomonas aeruginosa, Escherichia coli, Stenotrophomonas maltophilia. The main departments that pathogenic bacteria come from were respiratory medical department and ICU,and the main source of the pathogen specimen were sputum specimens. In addition to Klebsiella, Serratia, Acinetobacter Baumannii, Pseudomonas aeruginosa on the part of antimicrobial drug resistance rate were different (P < 0.05 ) between 2009 and 2010, but other gram-negative bacilli on antimicrobial resistance rates did not have obvious difference (P > 0.05 ) in 2009 and 2010. For Enterobacteriaceae, only Piperacillin / Tazobactam, Cefoperazone / Sulbactam, Imipenem, Meraopenem had maintained good antibacterial activity, but there are also some resistance, and resistance rates were from 0.0% to 17.0%.For other beta-lactam antibiotics had very high resistance rate,which might be related to the generation of Carbapenemase, Ampc metal enzyme, Extended-spectrum-β-lactamases . Escherichia coli on ciprofloxacin resistance rate is greater than 73.6%, and other Enterobacteriaceae on ciprofloxacin resistance rates were mostly from 15.0% to 23.0%. For Enterobacteriaceae, The resistance rates of Amikacin was significantly lower than those of gentamicin, which might be associated with the Amikacin rare clinical application and it had strong tolerance to enzyme. For Nonfermentative gram-negative bacilli, multiple drug resistance situation of Acinetobacter Baumannii were serious, besides the resistance rates of Cefoperazone / Sulbactam had difference (P< 0.05 ) in 2009 and 2010 ,and the resistance rates of other antimicrobial agent had not obvious difference.And only the Cefoperazone / Sulbactam has good antibacterial activity. In 2009, 17 strains of Pan resistant strains were detected, and 24 strains of Pan resistant strains were detected in 2010. Cause of serious resistance phenomenon might be related to the generation of Extended-spectrum-β-lactamases, Ampc enzyme, Carbapenemase and otherβ-lactamases, and aminoglycoside inactivating enzymes, gyrA /parC gene mutation and so on.Antimicrobial resistance rates of Pseudomonas aeruginosa and Stenotrophomonas maltophilia were much lower than 20%. The reason for this phenomenon was that probably medication starting point was low in our hospital or rotation dosing strategies were used well by doctors or originated from the colonization of bacteria and so on. For Enterobacteriaceae of ICU and non-ICU, , only the resistance rate of Enterobacter cloacae to ticarcillin / clavulanate had difference (P<0.05 ) in 2009 and 2010. In addition to Enterobacter cloacae, antibacterial activity of imipenem and meropenem was the strongest on other Enterobacteriaceae, followed by piperacillin / tazobactam, Cefoperazone / Sulbactam, Amikacin, and antibacterial activity of ampicillin was the worst. For non-fermenting Gram-negative bacteria from ICU and non-ICU ,the resistance rate of Acinetobacter baumannii from ICU to most antibiotics was significantly higher than that from non-ICU, and the resistance rates of Acinetobacter baumannii to most antimicrobial agents had differences between them (P<0.05). The antibacterial activity of Cefoperazone / Sulbactam is only the best to Acinetobacter baumannii, and the antibacterial activity of other antimicrobial agents to Acinetobacter baumannii remained higher resistant state. The reason for this situation is that patients in the ICU have common characteristics ,such as endotracheal intubation, tracheotomy , use of ventilator with a long hospital stay, serious underlying diseases, long-term application of broad-spectrum antibiotics and so on.This study shows that antimicrobia resistance of Gram-negative bacilli in our hospital is very serious.Only several antibiotics had good antibacterial activity,such as Piperacillin / Tazobactam, Cefoperazone / Sulbactam, Imipenem, Meropenem, Amikacin and so on. Most antimicrobial resistance rates to Acinetobacter baumannii were different (P<0.05) between the ICU and the non-ICUand remainded a high level of resistance. So Bacterial resistance surveillance works should have been finished well, which has far-reaching significance for guiding the rational use of antimicrobial drugs, reducing and delaying the emergence of resistant strains and effectively controlling nosocomial infections. |
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