临床常见分离菌对不同配比头孢哌酮/舒巴坦的药敏差异

目的了解临床常见病原菌对不同配比头孢哌酮/舒巴坦药敏纸片的耐药性，为临床合理选择头孢哌酮/舒巴坦提供依据。方法收集某院2014年上半年临床分离病原菌1 141株，采用纸片扩散法检测不同病原菌对头孢哌酮/舒巴坦两种药敏纸片(70/35 μg与75/75 μg)的抗菌活性。结果1 141株病原菌中肠杆菌科细菌675株（59.16%），非发酵菌447株(39.18%)，其他革兰阴性杆菌19株(1.66%)。对头孢哌酮/舒巴坦两种药敏纸片(70/35 μg、75/75 μg)的耐药率：超广谱β 内酰胺酶（ESBLs）阳性大肠埃希菌(eco，221株)分别为7.69%、2.26%,肺炎克雷伯菌(kpn，92株)分别为10.87%、3.26%；亚胺培南耐药鲍曼不动杆菌（IRAB 295株）分别为54.92％、11.19％；两种药敏纸片抗菌活性比较，差异均有统计学意义（P＜0.05）。ESBLs阴性肠杆菌科细菌（eco，135株；kpn，98株）、亚胺培南敏感鲍曼不动杆菌（51株）、铜绿假单胞菌（48株）、嗜麦芽窄食单胞菌（22株）对两种头孢哌酮/舒巴坦药敏纸片的耐药率比较，差异均无统计学意义（均P>0.05）。结论ESBLs阳性肠杆菌科细菌与IRAB对不同配比头孢哌酮/舒巴坦药敏纸片的抗菌活性具有差异，临床治疗此类细菌引起的感染时要充分考虑头孢哌酮/舒巴坦的剂型，以达到预期治疗效果。

Difference in antimicrobial susceptibility of common clinical pathogens to different ratios of cefoperazone / sulbactam antimicrobial disks

ObjectiveTo understand the antimicrobial resistance of common clinical pathogens to antimicrobial disks containing different ratios of cefoperazone/sulbactam, so as to provide basis for rational application of cefoperazone /sulbactam in clinic. Methods1 141 pathogens isolated from clinical specimens in a hospital in the first half year of 2014 were collected, disk diffusion method was adopted to detect antimicrobial activity of two kinds of cefoperazone/sulbactam disks (70/35 μg and 75/75 μg).ResultsOf 1 141 pathogenic strains, 675 （59.16%）were Enterobacteriaceae, 447 (39.18%) were non fermentative bacteria, and 19 (1.66%) were other gram negative bacilli. Resistance rates of pathogens to 70/35μg and 75/75 μg cefoperazone /sulbactam antimicrobial disks were as follows: extended spectrum β lactamases(ESBLs) producing Escherichia coli (n=221) were 7.69% and 2.26% respectively, ESBLs producing Klebsiella pneumoniae(n=92) 10.87% and 3.26% respectively, imipenem resistant Acinetobacter baumannii（IRAB,n=295）54.92％ and 11.19％respectively；there were significant differences in antimicrobial activity between two ratios of antimicrobial disks(P<0.05). While antimicrobial resistance rates of ESBLs negative Enterobacteriaceae (Escherichia coli,n=135; Klebsiella pneumoniae, n=98), imipenem sensitive Acinetobacter baumannii (ISAB, n=51), Pseudomonas aeruginosa (n=48 ), and Stenotrophomonas maltophilia (n=22) were not significantly different (all P>0.05). ConclusionAntimicrobial activity of two different ratios of cefoperazone/sulbactam antimicrobial disks to ESBLs producing Enterobacteriaceae and IRAB is different, attention should be paid to ratios of cefoperazone/sulbactam during the treatment , so as to achieve the desired therapeutic effect.