1994～2001年中国重症监护病房非发酵糖细菌的耐药变迁

目的 了解我国重症监护病房非发酵糖菌的耐药变迁。方法 1994-2001年,用E试验法检测全国32家医院分离的4450株非发酵糖细菌对亚胺培南等数10种抗生素的最低抑菌浓度（MIC）。用WHO NET-5软件分析数据。结果 7年中,主要的非发酵糖细菌为铜绿假单胞菌（46.9%)。不动杆菌属（31.0%)。嗜麦芽窄食单胞菌（9.2%)。总敏感率最高的是头孢哌酮/舒巴坦（78.6%)。亚胺培南（77.0%)。其次是头孢他啶（70.1%)。哌拉西林/三唑巴坦（69.5%)。阿米卡星（69.9%)。再次为头孢吡肟（63.0%)。环丙沙星（59.1%)。除嗜麦芽窄食单胞菌,洋葱伯克霍尔德菌之外,其他非发酵糖菌对亚胺培南,头孢哌酮/舒巴坦的敏感率分别为84.2%和77.4%。7年中铜绿假单胞菌对11种抗生素的敏感性都在下降,亚胺培南,头孢他啶,阿米卡星,头孢哌酮/舒巴坦,头孢吡肟,哌拉西林/三唑巴敏感率为70.0%-83.0%。对亚胺培南对不动杆菌的敏感率高达95.0%。且历年不减。其次是头孢哌酮/舒巴坦,对它的敏感率从1996年的88.0%降至2001年的69.0%。而对头孢他啶,头孢吡肟,哌拉西林/三唑巴坦,替卡西林/克拉维酸,庆大霉素,环丙沙星的敏感率只有45.0%-58.0%。嗜麦芽窄食单胞菌对头孢哌酮/舒巴坦,头孢他啶,替卡西林/克拉维酸的敏感率最高（78.0%-85.0%)。产碱杆菌属对头孢哌酮/舒巴坦,哌拉西林/三唑巴坦及亚胺培南敏感率高于80.0%;黄杆菌属仅对头孢哌酮/舒巴坦,哌拉西林/三唑巴坦敏感率高于70.0%;73.0%-86.0%的洋葱伯克霍尔德菌对头孢哌酮/舒巴坦,头孢他啶,头孢吡肟,哌拉西林/三唑巴坦敏感。结论 近7年非发酵糖菌对常用的广谱抗生素的敏感性在下降。目前迫切需要制定相关政策,延缓耐药的发展。

Changes of antimicrobial resistance among nonfermenting gram-negative bacilli isolated from intensive care units from 1994 to 2001 in China

OBJECTIVE: To investigate the antimicrobial resistance among nonfermenting gram-negative bacilli isolated from intensive care units (ICUs) during the past 7 years in China. METHODS: From 1994 to 2001, the minimal inhibitory concentrations (MICs) of imipenem and other ten antibiotics for 4450 strains of nosocomial nonfermenting bacteria isolated from the ICUs of 32 hospitals in China were determined by E test. WHONET-5 software was used to analyze the data. RESULTS: The most predominant pathogens were Pseudomonas aeruginosa (46.9%), Acinetobacter spp. (31.0%), and Stenotrophomonas maltophilia (9.2%). The susceptibility rates of these nonfermenting gram-negative bacilli to cefoperazone/sulbactam, imipenem, ceftazidime, piperacillin/tazobactam, amikacin, cefepime, and ciprofloxacin were 78.6%, 77.0%, 70.1%, 69.5%, 69.9%, 63.0%, and 59.1% respectively. Imipenem and cefoperazone/sulbactam were the most active agents against nonfermenting bacilli other than S.maltophilia and Burkholderia cepacia with susceptible rates 84.2% and 77.4% respectively. From 1994 to 2001, the activity of these 11 antibiotics against Pseudomonas aeruginosa decreased; the susceptibility rates of the nonfermenting gram-negative bacilli to imipenem, ceftazidime, amikacin, cefoperazone/sulbactam, cefepime, and piperacillin/tazobactam ranged from 70.0% to 83.0%. The susceptibility rate of Acinetobacter spp. to imipenem was 95.0% and remained unchanged for years. The susceptibility rate to cefoperazone/sulbactam came second, however, it was decreased from 88.0% in 1996 to 69.0% in 2001. The susceptibility rates to ceftazidime, cefepime, piperacillin/tazobactam, ticarcillin/clavulanic acid, gentamicin, and ciprofloxacin ranged from 45% to 58%. The susceptibility of Stenotrophomonas maltophilia was the highest to cefoperazone/sulbactam, ceftazidime, and ticarcillin/clavulanic acid (78% approximately 85%). Cefoperazone/sulbactam, piperacillin/tazobactam, and imipenem inhibited 80% of Alcaligenes spp. Only cefoperazone/sulbactam and piperacillin/tazobactam inhibited 70% of the strains of Flavobacterium spp; and 73% approximately 86% of Burkholderia cepacia were susceptible to cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime, and cefepime. CONCLUSION: In recent 7 years, the antimicrobial resistance among nonfermenting gram-negative bacilli has increased in China. Antibiotics policy is urgently needed in order to delay the resistance development.