1997—2001年不动杆菌属临床分离株分布特点有耐药性分析

目的 探讨临床分离的不动相菌属细菌在患者、季节性分布特点有耐药性现状。方法：1.菌种鉴定采用常规方法或用API试条和VITEK自动细菌分析仪；2.用WHONET5软件对不动杆菌菌种分布和药敏试验结果（Kirby-Bauer纸片扩散法）进行了统计分析。结果：1.临床分离的不动杆菌属细菌的标本来源主要以痰标本为主（74％）；鲍曼不动杆菌是最常见的菌种，检出数列临床常见细菌第八位；鲍曼不动杆菌的流行呈季节性分布，在潮热的夏季检出量大，在60岁以上老年人中的检出数占其总检出数的40.1%；2.鲍曼不动杆菌耐药谱分析结果表明，在二重耐药谱中以耐头孢他啶和哌拉西林多见（CP、4％）；三重耐药谱中主要为耐头孢他啶、环丙沙星和哌拉西林为主（CRP、10％）；四重耐药谱中以耐阿米卡星、头孢他啶、环丙沙星和哌拉西林为主（ACRP、15％）。结论：对临床分离的鲍曼不动杆菌应加强季节性和易感人群的耐药性监测，密切注意多重耐药株的出现。     

1992年上海地区细菌耐药性监测

本文报道１９９２年上海地区１３所医院９７１０株临床分离菌对１９种抗菌药物的耐药性监测结果。其中革兰氏阳性菌２５７２株（２６．５％），革兰氏阴性杆菌７１３８株（７３．５％），以大肠杆菌、绿脓假单胞菌和凝固酶阴性葡萄球菌为多见。甲氧西林耐药葡萄球菌（ＭＲＳＡ和ＭＲＳＥ）约占６０％。万古霉素对革兰氏阳性球菌仍有强大抗菌作用，耐药菌株出现在少数情况。伤寒及其他沙门菌属对氯霉素、氨芋西林和复方新诺明仍显示敏感，对喹诺酮类高度敏感，耐药率＜５％，志贺菌属对多数常用抗生素耐药，但对喹诺酮类显示敬感，尤其对话氟沙星耐药率仅为２％。几年来，多数肠杆菌科细菌和绿脓假单胞菌对哌拉西林、庆大霉素、阿米卡星的耐药率变化不大，对第三代头孢菌素和喹诺酮类耐药率有所增高，约１０～２０％。耐五种以上抗菌药的多重耐药株在某些病房呈相对集中趋势，并具有相同的耐药谱，提示可能有编码相同耐药性质粒的菌株在医院内流行和院内感染的存在。     

临床常见耐药性细菌的耐药机制

随着新的抗菌药物的不断出现和临床应用,引起医院感染的细菌种类也发生着变化,细菌耐药性的发展已成为抗感染治疗面临的一个严重问题,特别是对多种抗生素耐药的多重耐药性问题更引起人们的高度关注．现就耐药性细菌产生的原因和耐药机制论述如下。     

大肠埃希菌耐药性分析

目的 了解大肠埃希菌的耐药现状，为临床合理用药提供科学依据。方法 用常规法分离鉴定细菌，采用K－B纸片扩散法进行药敏试验。结果 大肠埃希菌对氨苄西林、阿莫西林／克拉维酸的耐药率已高达85％以上；对喹喏酮类，妥布霉素，庆大霉素的耐药率也高达58％－85％；对头孢类抗菌素的耐药率高于32％；耐药率低的分别是亚胺培南（0％）、头孢哌酮／舒巴坦（4％）、哌拉西林／他唑巴坦（4％）。产超广谱β-内酰胺酶的大肠埃希菌占33％。结论 大肠埃希菌对多种抗生素具有高度耐药性，须根据药敏结果合理选用抗生素。亚胺培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦可作为该菌抗感染治疗的最佳选择。     

1999～2000年北京和湖北地区金黄色葡萄球菌耐药性分析

目的：调查1999-2000年北京和湖北地区金黄色葡萄球菌临床分离株的耐药性状况。方法：采用K-B组片扩散法进行抗菌药物活性试验。结果：（1）甲氧西林耐药金黄色葡萄球菌（MRSA）的分离率存在地区差异；（2）北京地区和湖北地区金黄色葡萄球菌的标本来源以伤口分泌物和呼吸道标本为主，在呼吸道标本分离的金黄色葡萄球菌中，北京地区59.2%(161/272)，湖北地区39.9%(105/263)为MRSA菌株。（3）对于氯霉素，庆大霉素，红霉素，环丙沙星和复方碘胺甲恶唑，湖北地区MRSA的多重耐药谱主要为氯霉素，庆大霉素，红霉素，环丙沙星和复方磺胺甲唑（20.6%)和氯霉素，环丙沙星，红霉素，庆大霉素（9.1%)，而北京地区则以氯霉素，环丙沙星，红霉素，庆大霉素(14.4%)和氯霉素，环丙沙星，红霉素，庆大霉素（8.4%)为主；94）北京的甲氧西林敏感金黄色葡萄球菌（MSSA）对临床常用抗生素氯霉素，庆大霉素，环丙沙星和复方磺胺甲唑有较好的敏感性，湖北地区的MSSA除复方磺胺甲唑外对氯霉素，庆大霉素和环丙沙星也有较好的敏感性，结论：北京和湖北地区MRSA表型多重耐药谱存在差别，MRSA和MSSA对抗生素耐药性也有不同。     

1996～2001年内科、外科、ICU和门诊患者分离的金黄色葡萄球菌耐药性分析

目的 通过对1996～2001年60家三级甲等医院不同科别住院患者和门诊患者分离的金黄色葡萄球菌的耐药性分析，探讨不同科别来源菌株耐药率间的差别及变迁。方法 药敏试验采用纸片扩散法，用WHONET5软件分析结果。结果 6年间内科住院患者分离的金黄色葡萄球菌对苯唑陛西林的耐药率维持在40％；磺胺甲恶唑／甲氧苄啶(SMZ／TMP)和氯霉素的耐药率从1998年的51．4％和39．6％降低到2001年的36．2％和23．6％。外科住院患者分离菌株对苯唑西林的耐药率从1996年的26．3％增加到2001年的45．9％；庆大霉素和环丙沙星耐药率从1996年的24．6％和17．5％增到2001年的43．5％和43．1％。ICU患者分离的大多数菌株对苯唑西林和环丙沙星耐药。门诊患者分离菌株对苯唑西林的耐药率从1996年的17．2％增加到2001年的24．9％；环丙沙星的耐药率超过30％；SMZ/TMP的耐药率从1998年的61％降低到2001年的38．3％。结论 调查不同科别住院患者和门诊患者来源的金黄色葡萄球菌对常用抗生素耐药性的变迁和现状，对于临床抗感染治疗的经验用药具有一定的指导意义。     

1997～2001年不动杆菌属临床分离株分布特点和耐药性分析

目的探讨临床分离的不动杆菌属细菌在患者、季节性分布特点和耐药性现状.方法1.菌种鉴定采用常规方法或用API试条和VITEK自动细菌分析仪;2.用WHONET5软件对不动杆菌菌种分布和药敏试验结果(Kirby-Bauer纸片扩散法)进行了统计分析.结果1.临床分离的不动杆菌属细菌的标本来源主要以痰标本为主(74%);鲍曼不动杆菌是最常见的菌种,检出数列临床常见细菌第八位;鲍曼不动杆菌的流行呈季节性分布,在潮热的夏季检出量大,在60岁以上老年人中的检出数占其总检出数的40.1%;2,鲍曼不动杆菌耐药谱分析结果表明,在二重耐药谱中以耐头孢他啶和哌拉西林多见(CP、4%);三重耐药谱中主要为耐头孢他啶、环丙沙星和哌拉西林为主(CRP、10%);四重耐药谱中以耐阿米卡星、头孢他啶、环丙沙星和哌拉西林为主(ACRP、15%).结论对临床分离的鲍曼不动杆菌应加强季节性和易感人群的耐药性监测,密切注意多重耐药株的出现.     

临床常见的细菌耐药性问题

综述了细菌耐药菌株产生的原因及其耐药机制研究进展，并提出了在抗感染治疗中减少细菌耐药性的策略，为临床用药提供参考。     

细菌耐药性调查研究应注意的若干问题

自 20世纪 20年代青霉素问世以来,抗生素在保障人类健康中发挥了重要作用.不过,尽管抗生素的使用极大地降低了感染的发生率和患者的病死率,但细菌耐药性的出现和蔓延使得人类在抗感染治疗方面又面临诸多新困难.因此,了解细菌耐药性的产生与发展,避免临床不合理使用抗生素,帮助临床医师合理用药,开展细菌耐药性调查与监测就显得尤为重要.     

1998年延安地区细菌耐药性监测

报道 1998年延安地区 12 30株临床分离菌对常用抗菌药物的耐药性。采用药敏纸片扩散法 ,检出革兰阳性菌 353株 ( 2 8.7% ) ,革兰阴性菌 734株( 61.3% ) ,以大肠杆菌、凝固酶阴性葡萄球菌为多见。革兰阳性菌对青霉素的耐药率达 98% ,对头孢菌素类药耐药率为 10 %～ 2 0 %。革兰阴性菌对氨苄青霉素的耐药率为 80 % ,对头孢菌素类药耐药率为 30 % ,对喹诺酮类药物耐药率约为 10 %～ 2 0 %。     

Antimicrobial resistance patterns of clinical bacterial isolates in southwestern Ethiopia

OBJECTIVES: The aim of this study was to assess the pattern of bacterial resistance to antimicrobial agents in a hospital setting in Southwest Ethiopia. METHODS: The antimicrobial resistance pattern of common bacterial isolates was determined during January 2003 to July 2004. A total of 291 Gram-positive and Gram-negative bacterial strains were isolated from different clinical specimens. Specimens collected included ear discharges, throat and wound swabs, as well as urine, sputum, stool and blood The specimens were obtained from consecutively attending adults and children at the out patient departments of Jimma Hospital. The specimens were inoculated onto appropriate culture media. Targeted species were identified following standard procedures. Using different panels of antibiotics, susceptibility tests were performed using disc diffusion method as outlined by Kirby-Bauer method The profile of the commonly prescribed antimicrobial agents was studied in accordance with the principles established by the National Committee for Clinical Laboratory Standards. RESULTS: One hundred seventy six Gram-positive and 115 Gram-negative bacterial species were isolated. Of these included Staphylococcus aureus, Coagulase negative Staphylococci and Proteus species were isolated frequently in 72 (24.7%), 59 (20.3%) and 55 (18.9%) of the isolates, respectively. Antimicrobial susceptibility testes showed that methicillin resistant Staphylococcus aureus was found in 8.3% of the cases while methicillin resistant coaguuse negative staphylococci were detected in 10.3%. Of the Staphylococcus aureus isolates, 90.3% and 91.7% were resistant to penicillin and ampicillin, respectively. Two (7.1%) of S. pneumoniae strains and 100% of Enterococci were resistant to penicillin. Proteues spp were resistant to tetracycline, polymyxin B, chloramphenicol and ampicillin in 90.9%, 92.7%, 67.3% and 58.2%, respectively. Escherichia coli, Klebsiella spp and Citrobacter and Enterobacter spp were 100% resistant to ampicillin. P. aeruginosa, E. coli, Proteus spp, S. aureus and Enterococci spp showed multiple drug resistance. All bacterial isolates were susceptible to ciprofloxacin. CONCLUSION: There is an increasing trend of antimicrobial resistance in some bacterial species. Ciprofloxacin was highly) effective antimicrobial agent in vitro against majority of the bacterial isolates. Health personnel should be aware and take necessary measures to control further increases in bacterial resistance to antibiotics.     

Antimicrobial resistance phenotypes and genotypes of methicillin-resistant Staphylococcus aureus CC398 isolates from Spanish hospitals

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) of lineage CC398 is an emerging clone causing human infections but is mostly found in pigs. The aim of this study was to characterize the antimicrobial resistance phenotypes/genotypes of a collection of 137 MRSA CC398 isolates obtained in a previous study from 17 Spanish hospitals, using tetracycline resistance as marker for selection. A multidrug-resistant (MDR) phenotype was present in 79% of analysed isolates, with 17% of them resistant to at least six different antimicrobial families. All tetracycline-resistant isolates (n=137) carried the tetM gene and 75% also carried the tetK gene. Almost 50% of MRSA CC398 isolates showed macrolide and/or lincosamide resistance: a) 39% of isolates were ERY^R-CLI^R (all with constitutive phenotype), with 87% of them carrying the ermC gene, followed by msrA (25%), ermB (21%), vgaA (17%), ermA (6%), lsaB (4%), linA (2%), linB (2%), and ermT (2%, this isolate with the new spa-type t18071); and b) 9% of MRSA CC398 isolates showed the dissociated ERY^S-CLI^R phenotype carrying the linA, linB, lsaB and vgaA genes. Other antimicrobial resistance phenotypes in these MRSA CC398 isolates included resistance to ciprofloxacin (67%), aminoglycosides (21%), mupirocin (6%), chloramphenicol (4%) or fusidic acid (2%). The more common resistance genes detected for some of these antimicrobials were: aac(6’)-Ie-aph(2’’)-Ia (16%) and ant(4’)-Ia (12%) for aminoglycosides, and fexA (3%) for chloramphenicol. The high rate of MDR phenotypes with a wide range of antimicrobial resistance genes shown in this study reduce the potential therapeutic options in case of infections.     

Antimicrobial resistance of bacterial isolates from respiratory care wards in Taiwan: a horizontal surveillance study

A horizontal surveillance study was conducted to identify common bacteria and mycobacteria from 611 respiratory aspirates and 165 urinary samples from 611 patients hospitalised at 17 respiratory care wards (RCWs) in Taiwan. Some major resistance phenotypes, including meticillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis, and multidrug-resistant Pseudomonas aeruginosa (MDR-PA) and Acinetobacter baumannii (MDR-AB), were identified. Pulsotypes of ESBL-producing P. mirabilis isolates were determined by pulsed-field gel electrophoresis. The prevalences of MRSA, ESBL-producing E. coli (K. pneumoniae and P. mirabilis), carbapenem-resistant (resistant to imipenem and meropenem) P. aeruginosa, MDR-PA, carbapenem-resistant A. baumannii and MDR-AB were, respectively, 86.7%, 20.0% (50.7% and 24.1%), 18.4%, 1.2%, 32.1% and 8.9% for respiratory aspirates and 100%, 25.4% (27.3% and 25.0%), 48.3%, 10.3%, 50.0% and 21.4% for catheterised urinary samples. Among the 44 respiratory isolates of P. mirabilis with an ESBL phenotype, 22 different pulsotypes (>80% identity) were identified. Among 103 isolates of mycobacteria, 90 (87.4%) belonged to rapidly growing mycobacteria and 4 (4%) were Mycobacterium tuberculosis. Among the 404 patients with available clinical information, true infections were found in 28.0%, the most prevalent of which were urinary tract infection (20.5%) and ventilator-associated pneumonia (10.9%). High prevalences of various multidrug-resistant bacteria among the respiratory and urinary tracts of patients present a clinical difficulty in choosing empirical antibiotic treatment in RCWs.     

Multidrug resistance in bacterial isolates from blood cultures of haematology patients

The bacteria most frequently isolated from blood cultures of haematology patients in Warsaw were staphylococci (58.0%), Enterobacteriaceae (18.6%), non-fermenting rods (6.9%), enterococci (4.3%) and anaerobes (4.3%). Coagulase-negative staphylococci were the most common species isolated (92.7%) with 83.2% of these strains resistant to methicillin. Among enteric bacteria, 17.3% strains produced extended-spectrum-beta-lactamases. All eight isolates of enterococci showed high level resistance to aminoglycosides.     

泉州市细菌耐药监测网重点医院细菌耐药性监测研究

目的 监测细菌耐药性,依据细菌耐药状况、特点及发展趋势,指导临床用药.方法 监测2010年度泉州地区4所重点医院临床分离细菌耐药状况,以WHONET 5.5软件进行数据分析.结果 共分离得到致病菌4 160株,其中革兰阳性菌1 535株,占36.9％;革兰阴性菌2 625株,占63.1％.最常见的细菌依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌、铜绿假单胞菌.MRSA的检出率为18.5％;大肠埃希菌和肺炎克雷伯菌产ESBLs比率分别为56.1％和47.3％;铜绿假单胞菌对碳青酶烯类的耐药率约30％,对其他监测抗菌药物的耐药率均＜30％;鲍曼不动杆菌耐药率总体高于铜绿假单胞菌.结论 本地区的细菌耐药性水平与全国及其他地区存在一定的差异.     

1330株临床分离革兰阳性菌耐药性分析

目的 了解临床分离的革兰阳性菌对不同抗菌药物的耐药情况,为临床医师及时提供抗生素的耐药动向与耐药变迁为临床抗感染治疗提供选药依据.方法 用苯唑西林检测葡萄球菌临床分离株的敏感性,用纸片扩散法检测革兰阳性菌对四环素、红霉素、庆大霉素、氨苄青霉素、环丙沙星、头孢吡肟、复方磺胺甲噁唑、万古霉素、替考拉宁、利福平、克林霉素等抗菌药物的耐药结果.用E-test法检测对苯唑西林耐药的肺炎链球菌青霉素的MIC值.结果 1330株革兰阳性菌中耐甲氧西林的葡萄球菌对抗菌药物的耐药率显著高于对甲氧两林敏感的葡萄球菌.肠球菌属以粪肠球菌和屎肠球菌检出率最高,粪肠球菌对呋喃妥因、氨苄西林耐药率较低,屎肠球菌耐药性较强,仅对氯霉素、四环素耐药率较低.肺炎链球菌对四环素、克林霉素、红霉素有较高的耐药率,青霉素不敏感肺炎链球菌(PNSSP)的E-test检测结果以中介菌株为主,PNSSP的MIC值最高达到6μg/mL.结论 葡萄球菌、肺炎链球菌对万古霉素全部敏感,有仅发现1株耐万古霉素的屎肠球菌,万古霉素是临床治疗重症革兰阳性菌感染的首选药物.加强耐药性监测对指导临床合理使用抗菌药物具有重要意义.     

Molecular epidemiology and mechanisms of carbapenem resistance in Pseudomonas aeruginosa isolates from Chinese hospitals

We investigated the molecular epidemiology and carbapenem resistance mechanisms of 258 non-duplicate carbapenem-resistant clinical isolates of Pseudomonas aeruginosa collected from 2006 to 2007 at 28 hospitals in China. Up to 88% of the carbapenem-resistant isolates were multidrug-resistant. Pulsed-field gel electrophoresis (PFGE) revealed that levels of intrahospital and interhospital dissemination of clones were low. To assess the mechanisms leading to resistance, all 258 carbapenem-resistant isolates were analysed for expression of the chromosomal β-lactamase (AmpC), the porin important for entry of carbapenems (OprD) and an efflux system (MexAB-OprM) known to extrude some β-lactams. Carbapenem resistance was driven mainly by mutational inactivation of OprD, accompanied or not by hyperexpression of AmpC or MexAB-OprM. Metallo-β-lactamase genes were detected in 22 carbapenem-resistant isolates in China, belonging to eight pulsotypes. The bla_OXA-50 gene was detected among all of the carbapenem-resistant isolates, whereas the bla_GES-5 gene was detected in only one carbapenem-resistant isolate.     

2001年成都地区1819株临床分离菌耐药性监测

目的 调查成都市三所三甲医院临床分离致病菌的菌群分布及其对常用抗菌药物的耐药状况。方法 排除同一病人相同部位先后分离的重复菌株，共收集2001年成都市具代表性的三所三甲医院分离的部分临床致病菌1819株，采用美国临床实验室标难委员会(NCCLS)推荐的Kirby—Bauer法进行药物敏感试验，按NCCLS2000版标难判断结果，利用WHONET5软件进行统计和分析。结果 1819株菌中革兰氏阳性菌454株，占24．96％，革兰氏阴性菌1365株，占75．04％。最常见的革兰氏阳性菌为金黄色葡萄球菌和凝固酶阴性葡萄球菌，其中MRSA和MRCNS分别占28．40％和62．27％，末发现经证实耐万古霉素的金黄色葡萄球菌。最常见的革兰氏阴性菌依次为大肠埃希氏菌、铜绿假单胞菌、肺炎克雷伯氏菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌及阴沟肠杆菌等。其中大肠埃希氏菌对氟喹诺酮类药物、哌拉西林和庆大霉素的耐药率接近50％或在50％以上；阴沟肠杆菌和弗氏柠檬酸杆菌对头孢菌素的耐药率明显增高达80％，但对亚胺培南仍敏感；铜绿假单胞菌对头孢他啶和阿米卡星仍较敏感，但对亚胺培南的耐药率接近20％；嗜麦芽寡养单胞菌对头孢他啶、头孢砒肟、哌拉西林、阿米卡星和亚胺培南的耐药率分别达25．0％、34．0％、44．6％、72．3％和89．2％；鲍氏不动杆菌对第三代头孢菌素、阿米卡星、和喹诺酮类的耐药率为30％-50％，对亚胺培南的耐药率亦为11．8％，应引起临床高度重视。结论 细菌耐药率呈上升趋势，多重耐药也日趋严重，开展细菌耐药性监测，及时掌握耐药性变迁，对指导临床合理应用抗生素，有效地控制医院感染具有重要意义。     

Antimicrobial resistance and serotype distribution of Streptococcus pneumoniae isolates from Crete, Greece

Susceptibility to 14 antibiotics was determined for 125 clinical isolates of Streptococcus pneumoniae collected over a 3-year period in Crete, Greece. Twenty-three isolates (18.4%) showed intermediate resistance and 15 (12%) high-level resistance to penicillin. Erythromycin, chloramphenicol, tetracycline, trimethoprim-sulphamethoxazole and sparfloxacin resistance rates were 16.8, 10.4, 19.2, 24.8 and 9.6%, respectively. Multiple resistance was observed in 22 strains. Vancomycin and levofloxacin were the most active agents tested. The most prevalent serotype among penicillin-susceptible pneumococci was 14, followed by 9, 7 and 1, while among penicillin-intermediate or -resistant strains serotype 23 was predominant followed by 19 and 9. These results show that as well as a high level of penicillin resistance in this region, some strains are also resistant to other antibiotics and may show multi-drug resistance.