重症监护病房革兰阴性杆菌对常用抗菌药物体外抗菌活性研究

目的：了解重症监护病房革兰阴性杆菌的分布及常用治疗中重度感染的抗菌药物对其的敏感性，指导临床用药，方法：采用浓度梯度法共测定11种抗菌药物对303株革兰阴性杆菌的体外抗菌活性。结果：在重症观察病房中革兰阴性杆菌常见病原菌为铜绿假单胞菌（29.7%)。大肠埃希菌（19.1%)，肺炎克雷伯菌（15.2%)。不动杆菌（8.6%)，嗜麦芽窄食单胞菌（6.9%)和阴沟肠杆菌（6.9%)。治疗铜绿假单胞菌感染的常用药物的敏感性同国内其他文献比较有一定程度下降，31%（18/58）的大肠埃杀菌和15%（7/46）的肺炎克雷伯菌证实产ESBLs，ESBL菌合计的阳性率为24%，四代头孢菌素对于肠杆菌科细菌的敏感覆盖率较高于三代头孢菌素，对嗜麦芽窄食单胞菌敏感覆盖率较高的抗菌药是替卡西林/克拉维酸（95.2%)和头孢哌酮/舒巴坦（90.2%)。对不动杆菌敏感覆盖率较高的抗菌药是亚胺培南（100%）和头孢哌酮/舒巴坦（61.5%)。结论：定期进行细菌耐药性的监测，有助于合理应用抗菌药物。     

我院革兰阴性菌耐药情况分析

目的对我院革兰阴性菌的耐药情况进行分析,以指导合理使用抗菌药物,减少细菌的耐药性。方法分析2004年我院检验科细菌室的药敏试验,对其分离出的病原菌与相应抗菌药物进行敏感菌、耐药菌统计,并计算耐药率。结果抗菌药物的总耐药率≥50%者10种,占抗菌药物总数近1/3(构成比10/31),总耐药率在30%~50%的抗菌药物有11种,某些抗菌药物的总耐药率不高,但对个别革兰阴性菌高度耐药。结论临床上在使用抗菌药物时,应参考药敏试验,保证用药的科学性。     

ICU产ESBLs革兰阴性菌感染、耐药及防治

耐药菌株产超广谱β-内酰胺酶(ESBLs)是革兰阴性细菌耐β-内酰胺类抗菌素的主要原因。近年来,国内外学者对其研究较为深入,现对ICU产ESBLs革兰阴性菌感染的耐药、检测及防治等情况进行分析。     

革兰阴性菌的耐药机制

<正>目前,由于抗微生物药物的广泛应用和不恰当使用,病原菌对抗生素的敏感性发生了变化,产生了许多耐药机制,使经验性抗微生物治疗难以奏效。为此,笔者就几种主要革兰阴性菌的耐药机制作一综述。     

重症监护病房感染病原菌分布和耐药分析

目的分析重症监护病房(ICU)感染患者的病原菌分布及耐药性。方法收集ICU2010年1-12月各类感染标本,分离出病原菌528株,以法国生物梅里埃公司vitekII全自动细菌鉴定仪鉴定菌种,采用K-B法进行药物敏感实验,使用WHONET 5.6软件进行耐药分析。结果 528株病原菌中,革兰阴性菌80.3%,革兰阳性菌12.7%,真菌7.0%;铜绿假单胞菌位居第一(26.1%),其次是鲍曼不动杆菌24.2%,大肠埃希菌5.5%,肺炎克雷伯菌5.3%,金黄色葡萄球菌4.7%。铜绿假单孢菌和鲍曼不动杆菌的耐药率分别高于70.0%和78.0%(除头孢哌酮/舒巴坦和米诺环素),肠杆菌科细菌对头孢类的耐药率高于55.0%,对碳青霉烯类的亚胺培南和美洛培南耐药率分别为11.2%和10.1%。结论 ICU感染病原菌以革兰阴性菌为主,对多种抗菌药物耐药率高,应重视合理应用抗菌药,有效控制院内感染。     

重症监护病房耐药革兰阳性球菌感染的临床分析

<正>重症监护病房患者病情危重,侵袭性操作多,因此各种重症感染发生率高。其中,耐药革兰阳性球菌引起的感染因其比例越来越高、症状严重、病死率高、可选择的治疗药物少、预后差,成为日益严重的临床问题[1]。本研究回顾性分析     

我院革兰阴性菌的耐药情况

目的:了解我院临床分离革兰阴性菌的分布及耐药情况,指导临床合理使用抗菌药物.方法:对我院2012年1月~2014年12月门诊及住院患者G-球菌检查结果及药敏结果进行分析.结果:我院近三年医院感染的病原菌以G-球菌为主,构成比例前五位的分别是大肠埃希菌(22.95%)、肺炎克雷伯菌(13.87%)、铜绿假单胞菌(9.53%)、鲍曼不动杆菌(4.67%)和嗜麦芽窄食单胞菌(1.80%).产超广谱β-内酰胺酶菌分离率呈逐年上升趋势.药敏试验结果显示,所有病原菌对大多数β-内酰胺类和氨基糖甙类抗菌药有较高的耐药率,对亚胺培南敏感率最高,对喹诺酮类药物相对敏感.超广谱β-内酰胺酶菌仅对亚胺培南等少数药物敏感.结论:革兰阴性菌仍是临床感染的主要病原菌,病原菌对临床常用的抗菌药物广泛耐药.因此,应建立细菌耐药监测,根据监测结果对抗菌药物进行调整,以降低耐药菌株产生提高疗效.     

重症监护病房与普通病房多重耐药菌分布比较

重症监护病房( ICU)患儿常因病情危重、频繁接受各种侵入性操作等原因,易发生院内感染,特别是多重耐药感染.有文献报道ICU息儿发生院内感染的危险性要比普通病房患儿高5 ～10倍[1],给临床抗感染治疗带来困难.因此,及时了解和动态掌握不同病房细菌分布及耐药趋势,对指导临床合理运用抗生素及制定相应防治策略具有重要意义.     

近3年重症监护病房细菌耐药分析

目的了解重症监护病房(ICU)院内感染的流行病学及细菌耐药性变化情况.方法对本院ICU 2001年1月～2003年12月的所有分离菌株进行分析.结果共分离222株细菌,革兰阴性(G-)杆菌共127株(57.21%).革兰阳性(G )菌43株(19.36%).G-杆菌前3位是大肠埃希菌、铜绿假单胞菌、沙雷菌.G 球菌前3位分别是表皮葡萄球菌、金黄色葡萄球菌、粪肠球菌.对第三代头孢菌素耐药率较高,对亚胺培南、万古霉素保持较高的敏感性.结论ICU感染的细菌仍以G-杆菌为主,G 菌感染有上升趋势.细菌耐药率高.应根据细菌耐药监测,指导临床用药,以控制耐药菌的产生.     

E试验对监护病房革兰氏阴性杆菌的耐药性研究

目的 用E试验法对我院监护病房分离的200株革兰氏阴性杆进行13种抗菌剂的体外敏感度测定,同时用经典的试管双倍稀释法作比较,以评价E试验法在研究细菌耐药性方面的作用;进一步用头孢他啶／克拉维酸检测对头孢他啶MIC≥2μg/ml的菌株中的超广谱β－内酰胺酶（ESBL）产生菌。结果 药物的抑菌率分别是：亚胺培南91％,阿米卡星和头孢哌酮／舒巴坦均为82％,哌拉西林／三唑巴坦81％,头孢他啶76％,头孢哌酮和哌拉西林各为66％和68％,头孢噻肟、头孢曲松和替卡西林／克拉维酸均为60％,庆大霉素和环丙沙星各为57％和58％,头孢呋新35％。E试验法和试管法的符合率为78．9％,但前者重复性更好。从80株对头孢他啶MIC≥2μg/ml的菌株中筛选出ESBL产生菌9株,主要出现在大肠埃希氏菌中。结论 亚胺培南有较高抑菌率,且对ESBL产生菌有较好的抗菌活性;头孢哌酮和哌拉西林在分别加用β－内酰胺酶抑制剂后抗菌活性均有所提高,表明酶抑制剂的应用亦是对付产酶耐药菌的策略之一。E试验法在研究细菌耐药性的方法中具有准确性高,重复性好,操作方便等优点,值得在临床实验中推广使用。     

盐酸左氧氟沙星对325株分离细菌的体外抗菌活性研究

目的：研究左氧氟沙星的体外抗菌活性作用。方法：采用平板双倍稀释法测定盐酸左氧氟沙星的体外抗菌活性,并与其它2种常用氟喹诺酮类抗菌药物进行比较。结果：结果表明：盐酸左氧氟沙星的抗菌活性强,抗菌谱广。对金葡球菌、表葡球菌和肺炎链球菌的MIC90值分别为16mg/L,32mg/L,2mg/L,是氧氟沙星和环丙沙星的1／2－1／4,抑菌率为82．5％－94．7％;对大肠埃希氏菌、铜绿假单孢菌等革兰氏阴性菌的MIC50值为＜0．03mg/L-0.25mg/L,是氧氟沙星和环丙沙星的1／2－1／4,抑菌率为92．9％－100％。结论：盐酸左氧氟沙星是一种广谱菌药物。     

三种碳青霉烯类抗生素对ICU分离菌株的体外抗菌作用

为评价亚胺培南、帕尼培南与美罗培南的体外抗菌作用,用琼脂双倍稀释法测定从我院重症监护病房分离的230株革兰氏阴性菌的最低抑菌浓度（MIC）,并采用抑制剂增强的纸片扩散法测定大肠埃希氏菌和肺炎克雷伯氏菌超广谱β－内酰胺酶（ESBLs)。结果,50株肺炎克雷伯氏菌和17株大肠埃希氏菌中的ESBLs阳性率为61．2％。三种碳青霉烯类对阴沟肠杆菌、肺炎克雷伯氏菌、大肠埃希氏菌、不动杆菌等都具有高度的抗菌活性,且对产ESBLs菌株保持高度的抗菌活性。对嗜麦芽黄单胞菌高度耐药。提示碳青霉烯类抗生素是重症监护病人多重耐药菌感染的良好选择。     

鲍曼不动杆菌烧伤分离株广谱抗生素及消毒剂耐药基因研究

目的 研究鲍曼不动杆菌烧伤分离株对广谱抗生素的耐药性及所携带的广谱抗生素及消毒剂耐药基因.方法 测定20株分离自烧伤患者的鲍曼不动杆菌对四环素、米诺环素、氯霉素、利福平、复方磺胺甲噁唑5种广谱抗生素的敏感性,PCR检测catB、cmlA、arr-2/3、tetA、tetB、smr-2、emrE、dfrA1、dfrA5、dfrA7、dfrA12、dfrA17、dfrB5、qacE△l-sull和intI 共15种基因.结果 20株细菌对5种抗生素的敏感率分别为10%、100%、0、0和5%.tetB、qacE△l-sull和intl基因检出率均为95%(19/20),其余12种基因为阴性,且一株静脉导管分离株携带了上述3种基因.结论 本组鲍曼不动杆菌烧伤分离株对除米诺环素外的广谱抗生素耐药严重,并携带了四环素类和消毒剂耐药基因.应规范此类抗生素在养殖业中的使用,同时采取措施防止多重耐药菌株利用静脉导管在烧伤科传播.     

Susceptibility of bacteria isolated from lower respiratory tract infections to antibiotics (1981)

During the period from September 1981 to March 1982, 363 bacterial isolates were obtained as possible pathogens from 311 patients with lower respiratory tract infections at 12 medical institutions in Japan. Of these clinical isolates, mostly from the sputum, a total of 231 isolates including 19 strains of Staphylococcus aureus, 33 strains of Streptococcus pneumoniae, 90 strains of Haemophilus influenzae, 65 strains of Pseudomonas aeruginosa, 17 strains of Klebsiella pneumoniae and 7 strains of Escherichia coli were tested in vitro for minimal inhibitory concentrations (MIC) of 17 antimicrobial agents, and their antimicrobial susceptibility distribution and cumulative percentages of inhibited isolates by increasing concentrations of drugs were determined. The data were further analyzed to investigate the interrelation between such parameters as the age-distribution of patients by diseases of the respiratory system, sex and types of infection and the species and frequency of isolation of the organisms, and also the relationship between the antimicrobial chemotherapy prior to collection of clinical specimens and the species and incidence of the bacterial isolates. In respiratory infections, it is frequently that chemotherapy should be instituted with an appropriate drug even before the causative organism can be identified and assessed for its antimicrobial susceptibility. The present data may provide valuable informations in selecting appropriate drugs in practical, clinical use.     

Susceptibility of bacteria isolated from lower respiratory tract infections to antibiotics (1982)

Two hundred seventy-six bacterial strains were isolated as possible causative pathogens mainly from sputum in 248 patients with lower respiratory tract infections at 12 medical institutions in various parts of Japan during the period from September 1982 to March 1983. Of these, 272 isolates including 28 Staphylococcus aureus strains, 38 Streptococcus pneumoniae strains, 107 Haemophilus influenzae strains, 68 Pseudomonas aeruginosa strains, 17 Klebsiella pneumoniae strains, 9 Escherichia coli strains and 5 strains of other species were tested in vitro for MICs of various antibiotics, and their drug sensitivity distributions determined. Data were also analyzed for distribution of cases by clinical entities, age and sex, interrelations between the types of infections and the species and frequency of isolation of organisms, and relations of the antimicrobial regimens at collection of clinical specimens to the species and frequency of isolation of the organisms. It engenders great interest that there was a significant increase in frequency of S. aureus isolation within 7 days after antibiotic therapy, compared to pretreatment isolation frequency, in the 1982 series. This seems to deserve further investigation in detail. The H. influenzae strains isolated with the highest frequency in 1981 and those in 1982 were examined as to susceptibility to several representative antibiotics, with interdrug comparisons: ABPC vs. SBPC, CTM vs. CMZ, and CMX vs. LMOX. The isolates demonstrated high degrees of susceptibility to these drugs and there was no conspicuous change in bacterial sensitivity to the drugs.     

Susceptibility of bacteria isolated from lower respiratory tract infections to antibiotics (1983)

Bacterial isolates from the patients with pulmonary infections have been collected over these 3 years, in collaboration with investigators at 13 hospitals in various parts of Japan for the study on frequency of isolation of pathogens among the patients and their drug susceptibilities. Possible causative pathogens mainly isolated from sputum in patients with lower respiratory tract infections during period from September 1983 to March 1984, were collected. The frequency of bacterial isolates from the sputum and their drug susceptibility on H. influenzae among the various pathogens are discussed. The kinds of bacterial species isolated from the patients with respiratory tract infections associated with chronic bronchitis, chronic capillary bronchitis or bronchiectasis and their relative frequency of isolation were as follows; Total numbers of bacterial isolates collected from various hospitals were 220 strains in 1981, 168 strains 1982 and 258 strains in 1983. H. influenzae was always isolated with highest frequency of 50.5% in 1981, 45.8% in 1982 and 40.7% in 1983, and followed by P. aeruginosa (24.1%), S. aureus (8.2%), S. pneumoniae (7.3%) and K. pneumoniae (5.9%) and E. coli (4.1%) in 1981; P. aeruginosa (30.4%), S. pneumoniae (11.9%), S. aureus (4.8%), K. pneumoniae (3.0%) and E. coli (1.8%) in 1982; P. aeruginosa (26.7%), S. pneumoniae (10.1%), S. aureus (7.8%), K. pneumoniae (3.5%) and E. coli (3.5%) in 1983. The drug susceptibility test of H. influenzae to ampicillin (ABPC), piperacillin (PIPC), mezlocillin (MZPC), sulbenicillin (SBPC), gentamicin (GM), amikacin (AMK), cefotiam (CTM), cefmetazole (CMZ), cefoperazone (CPZ), cefotaxime (CTX), ceftizoxime (CZX), cefmenoxime (CMX) and latamoxef (LMOX) was done by using agar micro-broth dilution methods. H. influenzae was most markedly susceptible to cephems of the third generation, especially to CMX, CZX and CTX by which about 95% of H. influenzae tested were inhibited the growth under the concentration with less than or equal to 0.10 microgram/ml of the drugs. Furthermore, annual changes in susceptibility of H. influenzae to various antibiotics was analyzed over the period from 1981 to 1983. The frequency of S. pneumoniae isolated from patients with chronic bronchitis or bronchiectasis was about 10% in this survey. However, in the case of respiratory infections associated with bacterial pneumonia, the frequencies were as follows; 24.8% (77 cases/311 cases) in 1981, 17.7% (44 cases/248 cases) in 1982, and 11.0% (39 cases/355 cases) in 1983. The frequency of isolation of S. pneumoniae decreased every year.(ABSTRACT TRUNCATED AT 400 WORDS)     

2002年血液标本分离的革兰氏阳性球菌的耐药性

目的 评估血液标本分离的革兰氏阳性球菌的耐药性。方法 血液标本分离的革兰氏阳性球菌的药物敏感性试验采用纸片扩散法。用WHONET5软件分析试验数据。不同地区耐苯唑西林的金黄色葡萄球菌(MRSA)分离率的差异采用X^2检验。结果 (1)革兰氏阳性细菌导致的菌血症所占的比例为51．1％，其中革兰氏阳性球菌(不包括厌氧球菌)占革兰氏阳性菌的86、9％；(2)血液标本分离的MRSA占分离的金黄色葡萄球菌的39．6％，北京地区的分离率最高，并且近5年来有逐渐增加的趋势。血液标本分离的耐苯唑西林的凝固酶阴性葡萄球菌(MRCNS)占凝固酶阴性葡萄球菌的74．7％。凝固酶阴性葡萄球菌的耐药性高于金黄色葡萄球菌；(3)草绿色链球菌、β-溶血链球菌对红霉素、克林霉素的耐药率较高；肺炎链球菌中青霉素耐药株所占的比例小于37．5％；万古霉素耐药的肠球菌的检出率为4．5％。结论血液标本中分离的革兰氏阳性球菌对常用抗生素的耐药率非常高，对临床经验治疗带来很大的困难，需要加强监测。针对革兰氏阳性球菌所致的重症感染建议首选万古霉素。     

ICU革兰阴性菌对常用抗生素耐药的动态分析

目的：了解革兰阴性菌在ICU的分布和对常用抗生素的耐药性。方法：对2000年7月至2004年6月本院ICU所分离的革兰阴性菌菌株及体外耐药率的回顾性分析。结果：372株革兰阴性菌前六位的是铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、产气肠杆菌、嗜麦芽窄食单胞菌和鲍氏不动杆菌。亚胺培南／西司他丁对革兰阴性菌耐药率最低。结论：明确ICU的革兰阴性菌分布和抗生素的耐药性，有助于合理选择抗生素。     

Susceptibilities of bacteria isolated from patients with respiratory infectious diseases to antibiotics (1988)

Isolated bacteria from respiratory infectious diseases were collected in cooperation with institutions located throughout Japan, since 1981, and Ikemoto et al. have been examining sensitivities of the isolates to various antibacterial agents and antibiotics, relationships between the isolates and the backgrounds of the patients and so forth each year. We report here the research results for the year 1988. In 18 institutions around the entire Japan from October 1988 to September 1989, 554 strains of bacteria were isolated mainly from the sputa of 439 patients with respiratory infectious diseases and assumed to be the etiologic bacteria. MICs of various antibacterial agents and antibiotics against 68 strains of Staphylococcus aureus, 102 strains of Streptococcus pneumoniae, 120 strains of Haemophilus influenzae, 86 strains of Pseudomonas aeruginosa, 65 strains of Branhamella catarrhalis, 18 strains of Klebsiella pneumoniae and so forth, were determined, and the drug sensitivities of these strains were examined except for the strains which died during transportation. The drug sensitivities of the main strains were almost the same as those determined last year for each drug. However, S. aureus strains for which MICs of methicillin were higher than 12.5 micrograms/ml (methicillin-resistant S. aureus) accounted for 38.2%, and the frequency of drug resistant bacteria increased over last year's 18.2%. Also, we examined changes in the backgrounds of patients, the infectious diseases, and the etiologic bacteria and so forth. As to patient backgrounds, there were many infectious diseases found in a high age bracket, and the patients over age 60 accounted for 57.2% of the diseases. In the distribution by disease, bacterial pneumonia and chronic bronchitis accounted for greatest numbers of cases 32.1% and 31.4%, respectively, followed by bronchiectasis and bronchial asthma. As for frequencies of etiologic bacteria by disease, S. aureus (22.5%) and S. pneumoniae (15.4%) in pneumonia, S. pneumoniae (25.7%) and H. influenzae (24.1%) in chronic bronchitis, H. influenzae (32.5%) and P. aeruginosa (23.8%) in bronchiectasis, and H. influenzae (31.4%), S. pneumoniae and B. catarrhalis (20.0%) in bronchial asthma were the most frequent. Regarding effects of administration of antibiotics and isolates obtained on each day after infection, those bacteria which were isolated before antibiotic administration and which decreased after administration included S. pneumoniae, H. influenzae, and B. catarrhalis. Frequencies of S. aureus and P. aeruginosa, however, increased after antibiotic administration. Also, when dosing continued for more than 15 days, the frequency of P. aeruginosa increased rapidly.