新生儿病房不常见非发酵菌检出及药物敏感性分析

目的:探讨新生儿病房血培养不常见非发酵菌病原菌分布及药物敏感性状况。方法:对2012年6月—2013年10月昆明市延安医院收治的新生儿血培养阳性患儿进行回顾性分析。结果:49例血培养分离株为不常见非发酵菌,依次为嗜麦芽窄食单胞菌14株,唐菖蒲伯克霍尔德菌13株,木糖氧化无色杆菌11株,洋葱伯克霍尔德菌6株,洛菲不动杆菌5株。不常见非发酵菌对左旋氧氟沙星、米诺环素、复方新诺明仍保持较高敏感率,为80%~100%。嗜麦芽窄食单胞菌对氨基糖苷类及所有β-内酰胺类抗菌药物天然耐药,可选用抗菌药物极少;对其他不常见非发酵菌而言,含酶制剂抗菌药物如哌拉西林/他唑巴坦、头孢哌酮/舒巴坦敏感率>80%,其他常用抗菌药物敏感率差别较大,在0~100%之间。结论:上述不常见非发酵菌为条件致病菌。随着ICU抗生素选择压力增大,耐药菌株检出率高,治疗困难。     

铜绿假单胞菌对3种常用抗菌药物的单独和联合用药的药敏分析

目的：了解铜绿假单胞菌对3种常用抗菌药物的单独和联合药敏效果。方法：采用改良K－B法测定70株铜绿假单胞菌临床分离株对头孢哌酮／舒巴坦、环丙沙星和阿米卡星的单独和联合用药的药敏结果。结果：头孢哌酮／舒巴坦、环丙沙星和阿米卡星的单独耐药率分别为1．4％、52．9％和55．7％，全部联合药敏结果未见协同。头孢哌酮／舒巴坦和阿米卡星的联合药敏结果均为无关，而和环丙沙的联合药敏结果，一株拮抗，69株为无关，环丙沙星和阿米卡星的联合药敏结果，22株拮抗，48株为无关，结论：头孢哌酮／舒巴坦、环丙沙星和阿米卡星可能不宜联用。     

铜绿假单胞菌的药敏与头孢哌酮-舒巴坦等抗菌药物用药频度相关性

目的了解铜绿假单胞菌的药物敏感性(药敏)与头孢哌酮-舒巴坦等抗菌药物用药频度的相关性,为临床合理用药提供依据。方法分别统计我院2002—2008年头孢哌酮-舒巴坦等抗菌药物用药频度和铜绿假单胞菌的药敏,采用SPSS13.0统计软件用Sperman’s相关法对2种变量进行相关性分析。结果抗菌药物中头孢哌酮-舒巴坦耐药率最低,但2008年比2002年中敏率上升了291.0%,敏感率则呈下降趋势。相关性研究结果显示:头孢哌酮-舒巴坦的中敏率与哌拉西林-三唑巴坦、头孢哌酮-舒巴坦、3代头孢类用药频度呈正相关(r=0.857,P<0.05;r=0.929,P<0.01;r=0.786,P<0.05);头孢哌酮-舒巴坦的敏感率与本药、美罗培南、3代头孢类含酶抑制药用药频度呈负相关(r=-0.821,P<0.05;r=-0.786,P<0.05;r=-0.786,P<0.05),与头孢他啶、阿米卡星、左氧氟沙星(0.5g)用药频度呈正相关(r=0.821,P<0.05;r=0.929,P<0.01;r=1.000,P<0.01);左氧氟沙星(0.5g)用药频度分别与环丙沙星、阿米卡星、左氧氟沙星以及头孢哌酮-舒巴坦耐药率呈完全负相关(r=-1.000,P<0.01;r=-1.000,P<0.01;r=-1.000,P<0.01;r=-1.000,P<0.01);美罗培南耐药率与亚胺培南-西司他丁、哌拉西林-三唑巴坦、头孢吡肟耐药率呈完全正相关(r=1.000,P<0.01;r=1.000,P<0.01;r=1.000,P<0.01);头孢他啶和氨曲南的耐药率与其他药物用药频度及耐药率也有相关性。结论头孢哌酮-舒巴坦等抗菌药物的药敏与用药频度存在显著的相关性,近期临床应注意调整抗菌药物用药频度。     

铜绿假单胞菌对16种抗菌药物的敏感性分析

［摘要］目的了解铜绿假单胞菌对抗菌药物的敏感性,为临床用药提供参考。方法使用16种抗菌药物对临床分离出的172株铜绿假单胞菌进行药敏试验。 结果敏感性最高的前3种药物是多粘菌素、美罗培南、亚胺培南。耐药性有增加趋势的是β 内酰胺类、喹诺酮类、碳青霉烯类药物等。结论应加强对铜绿假单胞菌耐药性的监测,建议联合用药;对碳青霉烯类抗菌药物应限制性使用,以减缓铜绿假单胞菌多重耐药菌株的产生。     

克雷伯菌的药物敏感性分析

目的：为了解克雷伯菌的药物敏感性。方法：采用抗生素纸片法测定各种抗生素的敏感情况。结果：克雷伯菌对多数抗生素均较敏感，总敏感率达72．2％。结论：发生克雷伯菌感染时，可考虑选用头孢哌酮、头孢他定、阿米卡星、诺氟沙星等抗生素治疗。     

小儿败血症致病菌对常用抗菌药物敏感性分析

目的：了解引起小儿败血症主要致病菌对常用抗菌药物的敏感性。方法：用HX 21微生物分析仪进行细菌鉴定及检测抗菌药物的敏感性。结果：共分离G＋菌19株，G－菌22株。41株菌对几种头孢第三代药物及氨基苷类药物均较敏感。结论：对小儿败血症抗菌药物的使用应以药敏试验为基础，避免盲目使用抗菌药物。在未获得药敏试验前可选用头孢哌酮、头孢噻肟钠、头孢曲松钠作为一线药物，对于＞6岁患儿可选用氨基苷类药物，在临床医师严格指导下，谨慎使用喹诺酮类药物。     

非发酵菌感染及其抗菌药物治疗

目的指导临床合理使用抗菌药物。方法分析非发酵菌所致医院感染及耐药情况。结果非发酵菌在医院感染患者标本中的检出率有逐年增加的趋势。结论应引起临床和细菌学检验人员的高度重视。     

632株非发酵菌对10种常用抗菌药物耐药性分析

目的：了解非发酵菌的耐药情况。方法：应用K B纸片法测定632株非发酵菌对10种抗菌药物的耐药率。结果：632株非发酵菌中铜绿假单胞菌304株(48.10%)，对头孢曲松与头孢噻肟耐药率＞40.0%。嗜麦芽假单胞菌130株(20.57%)，对亚胺培南耐药率100.0%。不动杆菌125株(19.78%)，对头孢曲松耐药率69.6%。洋葱伯克霍尔德菌39株(6.17%)，对妥布霉素耐药率74.3%。结论：定期系统地对非发酵菌的耐药性监测，对合理使用抗菌药物有重要的指导意义。     

头孢哌酮/舒巴坦对346株革兰阴性杆菌抗菌活性的分析

目的：调查头孢哌酮/舒巴坦对医院常见革兰阴性杆菌的体外抗菌活性。方法：收集我院2007年1月～2009年12月从临床标本中分离到的革兰阴性杆菌346株,采用VITEK-32全自动微生物分析仪进行鉴定,用K-B纸片法对头孢哌酮/舒巴坦进行药敏实验。结果：医院肠杆菌科细菌以肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌为主;其对头孢哌酮/舒巴坦的耐药率分别为9.6%、3.2%、8.7%。非发酵菌以铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽寡养单胞菌为主,其对头孢哌酮/舒巴坦的耐药率分别为33.7%、17.1%、50%。结论：除嗜麦芽寡养单胞菌外,其余革兰阴性杆菌耐药率均〈40%,头孢哌酮/舒巴坦具有很强的体外抗菌活性,是治疗革兰阴性杆菌感染的理想药物。     

Antimicrobial susceptibility of corynebacteria isolated from ewe''s mastitis

The antimicrobial susceptibility of 50 coryneform isolates from subclinical mastitis in sheep was evaluated. Arcanobacterium pyogenes (five isolates) had a susceptibility pattern distinct from the Corynebacterium species tested. The Corynebacterium isolates could be divided in two groups according to the MIC values for ciprofloxacin. Their antimicrobial susceptibility was usually unpredictable and consequently antimicrobial susceptibility tests are necessary for clinical and epidemiological purposes.     

Antimicrobial susceptibility of non-fermenting Gram-negative pathogens isolated from cystic fibrosis patients

Non-fermenting Gram-negative bacteria (NFGNB) are increasingly cultured in respiratory samples from cystic fibrosis (CF) patients. This study determined the antimicrobial susceptibility of clinical CF respiratory isolates from distinct geographical regions. A total of 286 isolates (106 Stenotrophomonas maltophilia, 100 Burkholderia spp., 59 Achromobacter spp., 12 Pandoraea spp., 9 Ralstonia spp.) from the Netherlands, Northern Ireland, Spain, USA and Australia were tested. MIC_50/90 values and susceptibility categorisation were determined. Trimethoprim/sulfamethoxazole (SXT) was the most active compound for all micro-organisms (MIC₅₀, 0.12–4 mg/L; MIC₉₀, 1–16 mg/L). For S. maltophilia, 47% and 62% of isolates were susceptible to SXT according to CLSI and EUCAST breakpoints, respectively. Ceftazidime presented lower susceptibility (35%; MIC₅₀, 32 mg/L; MIC₉₀, 256 mg/L). MIC₉₀ values for tobramycin and colistin were >128 mg/L and >16 mg/L, respectively. Regarding Burkholderia, 72%, 56% and 44% were susceptible to SXT, ceftazidime and meropenem, respectively. For both ceftazidime and meropenem, MIC₅₀ and MIC₉₀ values were within the intermediate or resistant category. The most active antibiotics for Achromobacter spp. were SXT (MIC₅₀, 0.5 mg/L; MIC₉₀, 8 mg/L) and imipenem (MIC₅₀, 2 mg/L; MIC₉₀, 8 mg/L). SXT, imipenem and ciprofloxacin were active against 12 Pandoraea spp. (MIC₅₀, 0.12–4 mg/L; MIC₉₀, 1–8 mg/L). Ciprofloxacin (MIC₅₀, 4 mg/L) and SXT (MIC₅₀, 1 mg/L) were the only active antibiotics for Ralstonia spp. There were no statistically significant differences in susceptibility rates between countries. NFGNB other than Pseudomonas aeruginosa are potential pathogens in CF. SXT was demonstrated to be the most active compound against these isolates.     

Antimicrobial susceptibility of uncommonly isolated non-enteric Gram-negative bacilli

The frequency of occurrence and antimicrobial susceptibility patterns of 3059 non-enteric Gram-negative bacilli (NGB), other than Pseudomonas aeruginosa and Acinetobacter spp., consecutively collected as part of the SENTRY Antimicrobial Surveillance Program (1997-2003) were reviewed. During this period, a total of 221,084 bacterial isolates were collected from several clinical specimens worldwide, including 25,305 (11.5%) NGB. Acinetobacter spp. and P. aeruginosa accounted for 82.7% of the NGB isolates and have been excluded from this analysis. The antimicrobial susceptibility results of 3509 strains from 13 species/genera have been analysed in this review. The isolates were tested by reference broth microdilution methods in three central laboratories using common reagents and procedures. More than 30 antimicrobial agents were tested and the results for the 18 most active compounds are reported here. Stenotrophomonas maltophilia (2076 strains; 59.2%) was the most frequently isolated pathogen in this group, followed by Aeromonas spp. (385 strain; 11.0%), Burkholderia cepacia (269 strains; 7.7%), Pseudomonas fluorescens/putida (253 strains; 7.2%) and Alcaligenes spp. (236 strains; 6.7%). All other species/genera accounted for less than 3% of the isolates analysed. The antimicrobial agents with the most consistent activity against the NGB evaluated in the present study were the newer fluoroquinolones gatifloxacin and levofloxacin with 84.1 and 84.9% susceptibility overall. Trimethoprim/sulphamethoxazole was active against 85.3% of the isolates tested, but showed reduced activity against P. fluorescens/putida (22.1% susceptibility). Antimicrobial susceptibility varied significantly between species/genera and the geographical regions evaluated. Thus, proper identification and quantitative susceptibility testing will be required for the treatment of NGB infections. Extensive worldwide surveillance programmes remain extremely important to guide empirical antimicrobial therapy for rarely isolated pathogens and also for pathogens that are not routinely tested due to the lack of standardised susceptibility testing methods.     

临床分离91株摩氏摩根菌的药敏分析

目的探讨摩根菌对抗菌药物的体外敏感性，为临床合理用药提供参考。方法对我院2002年1月到2005年6月临床分离的91株摩氏摩根菌的来源和药敏情况进行统计分析。结果多种临床标本中均可分离到摩根菌，其中较多来自痰液（37．4％）及分泌物标本（27．5％）。住院及门诊患者均可发生摩根菌感染，以老年科（15株，16．5％）、骨科（11株，12．1％）居多。所有摩氏摩根菌株对氨苄西林、头孢唑林、头孢噻吩均耐药，对氨苄西林／舒巴坦（77．8％）、头孢呋肟（87．2％）及复方磺胺甲口恶唑（72．2％）耐药率也较高，而对哌拉西林／三唑巴坦、头孢吡肟、亚胺培南、阿米卡星的敏感性较好，敏感率分别为92．2％、85．7％、83．5％和94．5％。此外随年份增长摩根菌对各种抗生素的敏感性并无下降的趋势。结论在临床工作中应重视不常见致病菌引起的感染；哌拉西林／三唑巴坦、头孢吡肟、亚胺培南和阿米卡星等可作为临床治疗摩根菌感染的一线药物。     

Antimicrobial susceptibility and serogroups of Salmonella isolates from Riyadh, Saudi Arabia

The antimicrobial susceptibility and serogroups of 153 Salmonella strains isolated during a period of 22 months from both children and adults at a major teaching hospital in Riyadh, Saudi Arabia were studied. Antimicrobial susceptibility testing by comparative disc method and MIC determination by E-test method were performed on selected antimicrobial agents. For nalidixic acid and trimethoprim only the comparative disc method was used. Discrepancy between the two methods were noticed only in 1.3% of isolates. The majority of isolates from children (41%) were serogroup B, while those from adults (43%) were serogroup C1. The overall resistance was 16% to ampicillin and ampicillin/sulbactam, 13% to nalidixic acid, and 11% to chloramphenicol and trimethoprim/sulphamethoxazole. The resistance of Salmonella isolates to the so-called first line anti-Salmonella agents, i.e. ampicillin, chloramphenicol and trimethoprim/sulphamethoxazole, has increased compared to that reported 4 years ago from this Institution. Almost all isolates were susceptible to the second, and third generation cephalosporins, fluoroquinolones, aztreonam, mecillinam and gentamicin. Multiple drug resistance to two or more drugs was noticed in 16% of isolates, most of which were serogroup B. The majority of these multiple drug resistant isolates (96%) were ampicillin resistant and β-lactamase producers. Although these isolates showed reduced MICs to ampicillin/sulbactam, their MICs were still higher than the susceptibility breakpoint for this combination. The nalidixic acid-resistant isolates showed higher MICs to the fluoroquinolones compared to the nalidixic acid-sensitive isolates. Isolates from children showed higher resistance to some of the antimicrobial agents compared to those from adults.     

北京地区2家医院临床分离革兰阴性菌对头孢哌酮/舒巴坦的耐药性特征研究

摘要：目的 探讨头孢哌酮/舒巴坦对不同部位临床分离革兰阴性菌的耐药特点,为临床治疗选择提供依据。方法 回顾 分析北京两家医院2017年1月-2020年12月的耐药监测数据,使用Whonet 5.6软件分析不同感染部位的病原菌特点及头孢哌酮/ 舒巴坦对常见革兰阴性菌的耐药率,并与其他β-内酰胺类抗生素、酶抑制剂合剂以及常用抗生素的耐药率进行比较,CHISS统 计学软件对结果进行统计学分析。结果 泌尿道感染、血流感染及腹腔感染的病原菌以大肠埃希菌占绝对优势分别为56.5%、 36.5%和40.2%,而中枢神经系统感染以鲍曼不动杆菌为主(31.9%);临床常见病原菌对头孢哌酮/舒巴坦整体耐药率：大肠埃希 菌11.9%(37/310)、铜绿假单胞菌24.1%(71/295)、肺炎克雷伯菌24.6%(70/285)和鲍曼不动杆菌51.2%(348/680);对临床治疗棘手 的MDR鲍曼不动杆菌、铜绿假单胞菌、产超广谱β-内酰胺酶大肠埃希菌、肺炎克雷伯菌及碳青霉烯类耐药大肠埃希菌和肺炎克 雷伯菌的耐药率分别为：62.7%(256/409)、46.4%(55/119)、19.3%(30/155)、52.7%(71/135)、73.3%(6/8)和94.7%(59/62),耐药率 均显著低于第三代头孢菌素及其他加酶抑制剂复合抗生素(P＜0.05);研究的4种革兰阴性病原菌近4年对头孢哌酮/舒巴坦耐药率 增高明显。结论 临床常见革兰阴性病原菌不同菌种间对头孢哌酮/舒巴坦耐药率差异较大,可作为泌尿道感染、血流感染、腹 腔感染及脑脊液感染经验用药的首选;但需加强监测,采取策略防止其耐药率的快速上升。     

主要革兰阴性杆菌对亚胺培南耐药率的变迁

目的 了解革兰阴性杆菌对亚胺培南的耐药率变化.方法 收集2006年1至2009年12月我院就诊患者的标本分离获得的革兰阴性杆菌,采用美国Dade MicroScan公司生产的AutoSCAN4半自动鉴定仪及配套的生化反应药敏板进行鉴定,药敏试验方法采用Mic法.结果 共分离革兰阴性杆菌4822株,116个种,肠杆菌科细菌3184株,占66.0%;非发酵菌1536株,占31.9%;分离率前5位的细菌分别是大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、阴沟肠杆菌和鲍曼不动杆菌.肠杆菌科细菌对亚胺培南的耐药率较低,近4年内耐药率变化不明显;非发酵菌对亚胺培南的耐药率比较高,呈上升趋势;嗜麦芽窄食单胞菌的耐药率达100%;铜绿假单胞菌和木糖氧化产碱杆菌耐药率明显上升.结论 肠杆菌科细菌和非发酵菌是临床分离的主要革兰阴性杆菌,肠杆菌科细菌对亚胺培南的耐药率较低,非发酵菌对亚胺培南的耐药率比较高,呈上升趋势.     

头孢哌酮/三唑巴坦与头孢哌酮/舒巴坦随机对照治疗急性细菌性感染多中心临床试验

目的 评价国产头孢哌酮／三唑巴坦治疗急性细菌性呼吸道感染、泌尿道感染以及其他系统感染的有效性与安全性。方法 采用区组随机、平行对照、多中心试验设计，头孢哌酮／三唑巴坦和头孢哌酮／舒巴坦均为每次给药2.0g，静脉滴注30～60min，q12h或q8h，疗程7～14d。结果 本项试验共入选病例220例，因各种原因淘汰13例，进入疗效分析的病例数为207例，其中头孢哌酮／三唑巴坦组103例，头孢哌酮／舒巴坦组104例，治疗结束头孢哌酮／三唑巴坦与头孢哌酮／舒巴坦临床有效率分别为96．1％与94．2％，治疗各种细菌感染临床有效率分别为95．5％与94．3％，各种致病菌清除率分别为91．0％与89．7％，两组细菌产β-内酰胺酶阳性率为61．9％，两组不良反应发生率分别为4.7％与6.4％，上述结果经统计学处理均无显著性差异。药敏结果显示头孢哌酮／三唑巴坦与头孢哌酮／舒巴坦细菌敏感率结果相近，明显优于头孢哌酮，有显著差异。结论 头孢哌酮／三唑巴坦与头孢哌酮／舒巴坦在治疗临床常见的敏感细菌引起的呼吸道、泌尿道以及其他系统感染均有效、安全。     

临床常见革兰氏阴性杆菌对抗菌药物的耐药监测

目的了解医院内常见病原菌分布情况,对抗菌药物的耐药性进行回顾性统计分析。方法按《全国临床检验操作规程》第三版进行,对临床送检的标本,分离培养并进行药敏试验后统计分析。结果分离出病原菌前几位是铜绿假单胞菌、鲍曼不动杆菌、大肠埃希氏菌、肠杆菌属、肺炎克雷伯氏菌。分离阳性率前三位的标本是痰、尿、引流液。对抗菌药物耐药率较低是碳青酶烯类药物亚胺培南（IPM）0%,美洛培南（MEM）0%,酶复合抑制剂类药物头孢哌酮/舒巴坦（SCF）0%,哌拉西林/他唑巴坦（TZP）21.0%,头孢菌素类药物头孢吡肟（FEP）3.0%,头孢他啶（CAZ）8.0%,氨基糖苷类药物阿米卡星（AK）5.0%,喹诺酮类药物左氟沙星（LVF）10%。结论严格操作执行操作规范,加强细菌耐药性的监测,为临床合理用药提供依据。