2006年中国十家教学医院革兰阴性杆菌的耐药状况

目的 监测2006年我国革兰阴性杆菌的耐药性.方法 收集2006年9-12月10家教学医院987株非重复的革兰阴性杆菌.菌株经中心实验室复核后,采用琼脂稀释法测定美罗培南等广谱抗菌药物的最低抑菌浓度(MICs).结果 10种抗菌药物对于629株肠杆菌科细菌的抗菌活性的敏感率由大至小依次为:美罗培南(敏感率99.8%)、业胺培南(敏感率99.5%)、哌拉西林/三唑巴坦(91.3%)、阿米卡星(89.3%)、头孢吡肟(83.8%)、头孢哌酮/舒巴坦(79.7%)、头孢他啶(74.7%)、头孢噻肟(57.7%)、头孢曲松(56.6%)、环丙沙星(53.6%).大肠埃希菌中超广谱β内酰胺酶(ESBL)的发生率为59.0%,高于肺炎克雷伯菌(33.0%)和奇异变形杆菌(8.0%).对于大肠埃希菌和肺炎克雷伯菌,抗菌活性最高的依次是美罗培南、业胺培南(99.2%～100%)、哌拉西林/三唑巴坦(90.8%～97.0%)、阿米卡星(83.8%～92.4%).头孢吡肟对肺炎克雷伯菌的活性高于其对大肠埃希菌的活性(85.4%vs.65.2%).对于阴沟肠杆菌、产气肠杆菌、弗劳地柠檬酸菌,活性最高的依次为美罗培南、亚胺培南(99.2%～100%)、阿米卡星(85.2%～92.6%)、头孢吡肟(81.5%～85.9%)、哌拉西林/三唑巴坦(73.4%～87.2%)、头孢哌酮/舒巴坦(65.6%～77.7%)和环丙沙星(53.1%～72.3%).对于铜绿假单胞菌,活性最高的药物依次为阿米卡星(83.5%)、美罗培南(79.1%)、哌拉西林/三唑巴坦(74.1%)和亚胺培南(70.9%).鲍曼不动杆菌对于亚胺培南、美罗培南、头孢哌酮/舒巴坦的敏感性最高,敏感率分别为79.1%、73.4%、59.7%.多重耐药的鲍曼不动杆菌达到53.0%.对于洋葱伯克霍尔德菌,抗菌活性较高的依次是美罗培南(73.3%)、头孢他啶(73.3%)、哌拉西林/三唑巴坦(62.2%).结论 碳青霉烯类对肠杆菌科仍保持高活性,但鲍曼不动杆菌、铜绿假单胞菌的耐药件明显增加,值得关注.

Antimlcrobial resistance analysis among nosocomial gram-negative bacilli from 10 teaching hospitals in China in 2006

Objective To investigate antimicrobial resistance among nosocomial gram-negative bacilli in 2006.Methods About 987 consecutive and non-repetitive gram-negative bacilli were isolated from 10 teaching hospitals from Sep.to Dec.in 2006 in China.All of these isolates were sent to the central laboratory for reidentification and susceptibility testing.The minimal inhibitory concentration(MICs)of meropenem and other antibacterial agents were determined by agar dilution method.Results The activity of antibacterial agents against Enterobacteriaceae was as fol lows in descending order of susceptible rate: meropenem(susceptible rate 99.8%),imipenem(99.5%),piperacillin/tazobactam(91.3%),amikacin (89.3%),cefepime(83.8%),cefoperazone/sulbactam(79.7%),ceftazidime(74.7%),cefotaxime (57.7%),ceftriaxone(56.6%),ciprofloxacin(53.6%).The prevalence of extended-spectrum β-Iactamases(ESBL)was 59.0% in Escherichia coli,33.0%in Klebsiella pneumoniae and 8.0%in Proteus mirabilis.The most active agents against E.coli and K.pneumoniae were meropenem,imipenem(99.2%. 100%),piperacillin/tazobactam(90.8%-97.0%),and amikacin(83.8%-92.4%).Cefepime Was more active against K.pneumoniae than E.coli(85.4% vs.65.2%).Against E.cloacae,E.aerogenes and Citrobacter freundii,the most active agents were as follows in desecnding order:meropenem,imipenem (99.2%-100%),amikacin(85.2%-92.6%),cefepime(81.5%-85.9%),piperacillin/tazobactam (73.4%-87.2%),cefoperazone/sutbactam(65.6%-77.7%),and ciprofloxacin(53.1%-72.3%).The most active agents against Pseudomonas aeruginosa were amikacin(83.5%),followed by meropenem (79.1%),piperacillin/tazobactam(74.1%),and imipenem(70.9%).The most susceptible agents against Acinetobacter baumannii were imipenem(79.1%),meropenem(73.4%) and cefoperazone/ sulbaetam(54.7%).Mutiresistant A.baumannii increased up to 53.0%.The most active agents against Burkholderia cepacia were meropenem(73.3%),eeflazidime(73.3%),and piperacillin/tazobactam (62.2%).Conclusions Carbapenems remained very high activity against Enterobacteriaceae.Increasing resistance to 10 antimicrobials agents tested from A.baumanni and P.aeruginosa brought great concern.