Mohnarin 2006-2007年度报告：非发酵革兰阴性杆菌耐药性监测

目的了解2006~2007年度全国84家医院中非发酵革兰阴性杆菌的分布情况及对各类抗菌药物的耐药性。方法药物敏感性试验采用纸片扩散法,耐药性数据分析采用WHONET5.4软件进行统计分析。结果共收集非发酵革兰阴性杆菌分离株22983株,菌株数列前6位的菌种为假单胞菌属(48.2%)、不动杆菌属(31.4%)、嗜麦芽寡养单胞菌(11.5%)、伯克霍尔德菌属(2.9%)、金黄杆菌属(2.1%)和产碱杆菌属(1.4%)。铜绿假单胞菌对左氧氟沙星、哌拉西林、头孢哌酮/舒巴坦、环丙沙星、头孢吡肟、头孢他啶、哌拉西林/三唑巴坦、美罗培南和阿米卡星敏感性范围从56.3%至73.8%;不动杆菌对亚胺培南和美罗培南的敏感率分别为77.3%和75.6%;头孢哌酮/舒巴坦69.9%,米诺环素69.4%。不动杆菌对本次研究中的其它抗菌药物耐药率高于38.8%。嗜麦芽寡养单胞菌对米诺环素、复方磺胺甲口恶唑和左氧氟沙星的敏感性分别为96.8%、82.8%和82.2%;洋葱伯克霍尔德菌对米诺环素、复方磺胺甲口恶唑、头孢他啶和美罗培南的敏感性分别为89.3%、72.9%、65.4%和62.9%。结论非发酵菌在临床分离比重大,细菌耐药明显,临床应采取积极措施,合理使用抗菌药物,减少耐药菌发生。     

Mohnarin 2008年度报告:非发酵革兰阴性杆菌耐药性监测

目的 了解2008年度全国89家医院中非发酵革兰阴性杆菌的分布情况及对各类抗菌药物的耐药性.方法 药物敏感性试验采用纸片扩散法,耐药性数据分析采用WHONET 5.4软件进行统计分析.结果 共收集非发酵革兰阴性杆菌分离株41956株,菌株数列前6位的菌种分别为假单胞菌属(46.8%)、不动杆菌属(35.1%)、嗜麦芽寡养单胞菌(10.3%)、伯克霍尔德菌属(2.8%)、金黄杆菌属(1.7%)和产碱杆菌属(1.3%).铜绿假单胞菌对左氧氟沙星、头孢哌酮/舒巴坦、哌拉西林、环丙沙星、头孢吡肟、亚胺培南、哌拉西林/三唑巴坦、头孢他啶、美罗培南和阿米卡星的敏感性范围分布为从56.8%至72.8%.对碳青霉烯类不敏感的铜绿假单胞菌除对多黏菌素B、阿米卡星、头孢他啶和哌拉西林/三唑巴坦的敏感性分别为93.3%、51.8%、45.4%和41.1%外,其它抗菌药物的敏感率大多在40%以下.不动杆菌对亚胺培南和美罗培南的敏感率分别为60.1%和56.6%;头孢哌酮/舒巴坦为61.1%,米诺环素为66.7%.不动杆菌对本次研究中的其他抗菌药物耐药率高于46.5%.对碳青霉烯类不敏感鲍曼不动杆菌对其它所有药物的敏感性都很低,其中敏感性最高的米诺环素和头孢哌酮/舒巴坦的敏感性分别为54.6%和33.2%.嗜麦芽寡养单胞菌对米诺环素、复方磺胺甲噁唑和左氧氟沙星的敏感性分别为91.6%、81.7%和81.2%;洋葱伯克霍尔德菌对米诺环素、复方磺胺甲噁唑、头孢他啶和美罗培南的敏感性分别为66.1%、67.4%、65.2%和58.8%.结论 全国细菌耐药性监测数据,为临床合理应用抗菌药物提供参考数据.     

哌拉西林/舒巴坦对非发酵菌体外抗菌活性研究

目的 评价哌拉西林/舒巴坦对非发酵菌体外抗菌活性.方法 采用微量肉汤稀释法测定哌拉西林/舒巴坦对细菌的体外抗菌作用.结果 北京、天津、广州、哈尔滨和重庆5个城市的8家医院共收集菌株809株.对于所有铜绿假单胞菌,在8种测试药物中,哌拉西林/舒巴坦的敏感率最高(71.9%),而亚胺培南、头孢吡肟、头孢他啶、头孢哌酮/舒巴坦敏感率都低于50%.对于亚胺培南不敏感的铜绿假单胞菌,哌拉两林/舒巴坦敏感率仍可达55.8%.对于碳青霉烯敏感的鲍曼不动杆菌,哌拉西林/舒巴坦和头孢哌酮/舒巴坦敏感率最高,分别为71.0%和73.0%.对于嗜麦芽寡养单胞菌,26%和20%的菌株对哌拉西林/舒巴坦和哌拉两林/三唑巴坦的MIC≤16μg/mL.对于洋葱伯克霍尔德菌,69%的菌株对哌拉两林/舒巴坦的MIC≤16μg/mL.对于黄杆菌属和产碱杆菌属,哌拉西林/舒巴坦、头孢哌酮/舒巴坦和哌拉西林/三唑巴坦3种酶抑制剂复合制剂敏感率最高,分别为70.2%、63.2%、57.9%和94.4%、94.4%、91.7%.结论 哌拉西林/舒巴坦对于多种非发酵菌具有良好的体外抗菌活性.对碳青霉烯不敏感的铜绿假单胞菌具备一定的抗菌优势,哌拉西林/舒巴坦是经验性治疗非发酵菌感染(包括复数菌感染)的的适宜选用药物之一.     

调查分析头孢哌酮/舒巴坦体外抗菌活性及稳定性

目的调查分析2002～2007年头孢哌酮/舒巴坦对临床分离的3500株革兰阴性杆菌的体外抗菌活性的变化,并与亚胺培南及其他抗菌药物进行比较,以了解头孢哌酮/舒巴坦的抗菌作用和稳定性。方法收集临床分离的革兰阴性杆菌3500株,检测其对8种抗生素的敏感性。结果在五年观察中,头孢哌酮/舒巴坦对肠杆菌科细菌的抗菌作用仅次于亚胺培南,对铜绿假单胞菌、不动杆菌属和嗜麦芽寡养假单胞菌也具有良好的抗菌作用。2002～2006年,头孢哌酮/舒巴坦对肠杆菌科细菌、非发酵菌抗菌活性的稳定性较高;2007年,对不动杆菌属、嗜麦芽寡养假单胞菌仍保持较高的稳定性,但对肠杆菌科细菌、铜绿假单胞菌的稳定性有下降的趋势。结论对临床常见的多重耐药的革兰阴性杆菌,头孢哌酮/舒巴坦与喹诺酮类、氨基糖苷类、头孢菌素类等抗生素相比有较强的抗菌活性,稳定性较好,表明头孢哌酮/舒巴坦是一种具有良好的临床应用前景的广谱抗菌药。     

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。     

脑卒中肺部感染洋葱伯克霍尔德菌的耐药分析

目的 监测脑卒中肺部感染洋葱伯克霍尔德菌的耐药状况.为临床用药提供参考.方法 收集某医院2008年9月至2011年8月76株脑卒中肺部感染洋葱伯克霍尔德菌患者的标本,复核后采用琼脂稀释法进行体外敏感试验,按照美国临床和实验室标准协会(CLSI)2007年的标准测定MIC,以MIC50 和MIC50表示抗菌药物的抗菌活性,并计算出耐药率(R%)和敏感率(S%).结果 12种抗菌药物对洋葱伯克霍尔德菌敏感率较高的有:复方磺胺甲恶唑,美罗培南,哌拉西林/三唑巴坦以及头孢哌酮/舒巴坦.结论 洋葱伯克霍尔德菌是一种多重耐药且耐药率较高的细菌,临床应根据药敏结果 选用抗菌药物.     

重症监护病房非发酵菌感染分布特点及耐药情况分析

目的分析我院重症监护病房(ICU)非发酵菌感染分布及其耐药情况。方法对2009年1月至2011年12月,从我院ICU患者各类临床标本分离的非发酵菌株作体外药敏试验并对结果进行回顾性分析。药敏试验采用MIC法及K-B法,按CLSI 2010年版判断标准。结果共分离非发酵菌447株,其中前4位的分别是鲍曼不动杆菌207株(46.31%)、铜绿假单胞菌144株(32.21%)、嗜麦芽窄食单胞菌49株(10.96%)和伯克霍尔德菌36株(8.05%)。鲍曼不动杆菌仅对头孢哌酮/舒巴坦耐药率较低,为1.55%,对亚胺培南、美洛培南耐药率分别为49.61%和53.48%。铜绿假单胞菌对亚胺培南、美洛培南、阿米卡星及头孢哌酮/舒巴坦耐药率较低,分别为25.95%、29.01%、35.11%和0.76%,嗜麦芽窄食单胞菌及伯克霍尔德菌对多种抗菌药物天然耐药,对复方新诺明,喹诺酮类药物耐药率较低。推荐临床治疗使用。结论非发酵菌是重症监护病房感染常见病原菌,对常用抗菌药物耐药情况严重。应加强耐药性监测,为临床合理应用抗生素,防止院内感染提供依据。     

头孢哌酮/舒巴坦体外抗菌活性及稳定性研究

目的调查分析2003～2006年头孢哌酮／舒巴坦对临床分离的5100株革兰阴性杆菌的体外抗菌活性的变化，并与亚胺培南及其他抗菌药物进行比较，以了解头孢哌酮／舒巴坦的抗菌作用和稳定性。方法收集临床分离的革兰阴性杆菌5100株，检测其对8种抗生素的敏感性。结果在四年观察中，头孢哌酮／舒巴坦对肠杆菌科细菌的抗菌作用仅次于亚胺培南。对铜绿假单胞菌、不动杆菌属和嗜麦芽寡养假单胞菌也具有良好的抗菌作用，且稍强于亚胺培南和哌拉西林／三唑巴坦（嗜麦芽寡养假单胞菌对亚胺培南天然耐药）。2003～2005年，头孢哌酮／舒巴坦对肠杆菌科细菌、非发酵菌抗菌活性的稳定性较高；2006年，对不动杆菌属、嗜麦芽寡养假单胞菌仍保持较高的稳定性，但对肠杆菌科细菌、铜绿假单胞菌的稳定性有下降的趋势。结论对临床常见的多重耐药的革兰阴性杆菌，头孢哌酮／舒巴坦与喹诺酮类、氨基糖苷类、头孢菌索类等抗生索相比有较强的抗菌活性，稳定性较好，表明头孢哌酮／舒巴坦是一种具有良好的临床应用前景的广谱抗菌药。     

住院患者常见非发酵糖革兰阴性杆菌的分布及耐药性分析

目的:了解住院患者常见非发酵糖革兰阴性杆菌的临床分布和耐药特征,为临床抗感染治疗提供参考依据。方法:收集汕头潮南民生医院2009年4月1日～2010年3月31日住院患者送检标本分离的细菌,采用微量稀释法和部分纸片扩散法(Kirby-Bauer法)进行药敏试验,结果判断按照美国临床实验室标准化研究所(CLSI)2007年版标准。结果:临床分离的156株非发酵糖革兰阴性杆菌中,铜绿假单胞菌49株(31.4%),不动杆菌属74株(47.4%)以及嗜麦芽窄食单胞菌33株(21.2%)。对铜绿假单胞菌敏感率较高的是多粘菌素E(100.0%)、哌拉西林/他唑巴坦(93.9%)、美罗培南(91.8%)、头孢哌酮/舒巴坦(91.8%);对不动杆菌属敏感率较高的是多粘菌素E(100.0%)、头孢哌酮/舒巴坦(74.3%)、亚胺培南(29.7%)和美罗培南(41.9%),对其余14种抗菌药物耐药率均在70%以上;对嗜麦芽窄食单胞菌敏感率较高的是复方磺胺甲唑(100.0%)、左氧氟沙星(72.7%),对其余16种抗菌药物多数呈高度耐药。结论:非发酵糖革兰阴性杆菌是引起医院感染的主要病原菌,对多种抗菌药物呈高度耐药,临床应密切监测并根据药敏试验结果合理选用抗菌药物,避免滥用,以减少耐药菌株的产生;同时应加强对医院环境消毒和增强医务人员的无菌操作意识。     

2008年本院细菌耐药性监测

目的:了解某院临床送检标本分离株的抗菌耐药性。方法:采用K-B法,参照2008年CLSI判定标准判断结果,并用WHONET5.4软件进行数据处理。结果:1075株非重复菌株中,革兰阳性球菌246株(22.9%),革兰阴性杆菌829株(77.1%)。前5位病原菌为大肠埃希菌、铜绿假单胞菌、克雷伯菌属、不动杆菌属、凝固酶阴性葡萄球菌。MRSA、MRCNS的检出率为52.7%、79.3%。未有万古霉素不敏感菌株。产ESBLs大肠埃希菌、克雷伯菌属的检出率62.4%、28.9%,变形杆菌属对大多数抗菌药物的耐药率低于30%,肠杆菌属对大多数抗菌药物的耐药率大于40%。碳青霉烯类(亚胺培南)对肠杆菌科细菌抗菌活性较好。除头孢哌酮/舒巴坦外,不动杆菌属对其他抗菌药物的耐药率均高于铜绿假单胞菌。结论:某院临床常见病原菌革兰阴性杆菌占绝大多数,碳青霉烯类(亚胺培南)对肠杆菌科细菌抗菌活性最好,临床常见细菌对常用抗菌药物耐药性严重。     

The susceptibility of non-fermentative Gram-negative bacilli to cefperazone and sulbactam compared with other antibacterial agents

This study was designed to determine the bacterial susceptibility of non-fermentative Gram-negative organisms to various antibacterial agents. Bacterial susceptibility testing used the Kirby-Bauer method and data were assessed according to NCCLS 2000. Cefoperazone/sulbactam (CPER/SU) had good antibacterial activity against Pseudomonas aeruginosa. Its activity was next only to that of imipenem, meropenem and ceftazidime. CPER/SU was highly active against Acinetobacter spp., Alcaligenes spp., Burkholderia spp., Stenotrophomonas maltophilia and Flavobacterium spp., while the majority of strains of the latter two species were resistant to imipenem and meropenem. Of 3905 isolates tested, 39.5% were susceptible to CPER, 70.4% to CPER/SU. The resistance rate was 37% for CPER and 10.8% for CPER/SU.     

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.     

Prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in female outpatients in South Korea: a multicentre study in 2006

The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII) conducted a survey of the antimicrobial susceptibility patterns of uropathogens responsible for female acute uncomplicated cystitis in South Korea in 2006. KAUTII has already reported similar data in 2002, which are compared with the results of the present study. This study was carried out with the participation of 22 hospitals in South Korea. A total of 301 isolates were obtained from female outpatients with acute uncomplicated cystitis. The antimicrobial susceptibilities to commonly prescribed drugs were determined. The most prevalent causative organism was Escherichia coli (71.1%), followed by enterococci (13.0%), coagulase-negative staphylococci (5.3%) and other species of Enterobacteriaceae (10.6%). Among all Enterobacteriaceae isolates, 31.4% were susceptible to ampicillin, 52.3% to ampicillin/sulbactam, 97.6% to piperacillin/tazobactam, 78.9% to ciprofloxacin, 80.3% to gatifloxacin, 86.8% to cefazolin, 99.6% to amikacin, 80.5% to gentamicin, 81.1% to tobramycin and 73.9% to trimethoprim/sulfamethoxazole (TMP/SMX). The resistance rates of E. coli to ciprofloxacin and gatifloxacin were 23.4% and 21.8%, respectively, and 12 (11.8%) of 102 suspected strains were confirmed as producing extended-spectrum beta-lactamase (ESBL). All the ESBL-producing strains were also resistant to fluoroquinolones. Enterobacteriaceae were highly susceptible to piperacillin/tazobactam and amikacin (>97%). There was a small increase in susceptibility to TMP/SMX (73.9%) compared with the same study in 2002 (62.1%). Similar to 2002, the high prevalence of resistance to ampicillin, ampicillin/sulbactam and TMP/SMX still exists. The increasing number of ESBL-producing or fluoroquinolones-resistant strains remains a serious clinical problem in South Korea.     

下呼吸道感染非发酵菌的流行情况和耐药现状

目的 总结我院2004年下呼吸道感染住院患者非发酵菌的流行情况及耐药现状。为临床合理应用抗菌药物提供指导依据。方法 收集2004年我院下呼吸道感染住院患者痰培养结果为非发酵菌的数据，用WHONET5软件统计分析。结果 2004年我院下呼吸道感染住院患者痰培养非重复阳性标本共1367份，革兰阴性菌684株；非发酵菌321株（占所有病原体的23．5％，占革兰阴性菌的47％），其中，铜绿假单胞菌152株，占47％；不动杆菌属共106株，占33％；嗜麦芽寡养单胞菌28株，占9％；洋葱假单胞菌17株，占5％。铜绿假单胞菌对哌拉西林／三唑巴坦敏感率最高．对亚胺培南、阿米卡星、头孢他啶尚敏感；不动杆菌属对亚胺培南、哌拉西林／三唑巴坦和头孢哌酮／舒巴坦较敏感；嗜麦芽寡养单胞菌、洋葱假单胞菌对左氧氟沙星、哌拉西林／三唑巴坦和头孢哌酮／舒巴坦较敏感。结论 下呼吸道感染病原体中非发酵菌占据越来越大的比例，减少医源性感染、合理选用抗菌药物对提高治愈率至关重要。     

下呼吸道标本不动杆菌的耐药性监测

为了解下呼吸道标本不动杆菌的耐药情况,以有助于临床合理用药,我们于１９９５年１月至１９９８年１２月期间对本院临床下呼吸道标本进行培养,分离鉴定,研究不动杆菌的分离率,并以Ｋ－Ｂ进行药敏试验,结果：⑴下呼吸道标本中分离到细菌４５８１株,其中不动杆菌６０７株占１３．３％,在各病原菌中占第２位,且以鲍氏不动杆菌为主（４３６株）,占不动杆菌７１．８％;⑵对１３种抗生素的耐药监测发现,不动杆菌对亚胺培南、阿     

In vitro activity of ampicillin, cefoperazone, their combinations with sulbactam and other antimicrobials: survey of Russian isolates

Methodological differences makes it difficult to compare results of antimicrobial susceptibility testing obtained in Russia and in other regions. During the period from October 1993 to May 1994 susceptibility of 1296 isolates of bacteria was investigated according to NCCLS standards by the broth microdilution method. The order of activity of antibiotics against Gram-negative bacteria based on percent of susceptible strains from common hospitals were: amikacin (98%) > ciprofloxacin (93%) = imipenem (93%) > cefoperazone/sulbactam (92%) > ceftazidime (89%) > ceftriaxone (81%) > cefotaxime (80%) > cefoperazone (77%) > gentamicin (71%) > ampicillin/sulbactam (51%) > cefazoline (45%) > ampicillin (25%). The order of activity against strains from teaching hospitals was similar but the percent of susceptible strains was 10-20% less for the majority of antibiotics. The susceptibility level of Gram-negative isolates from Moscow teaching hospitals is lower than from Northern America and Europe. Ampicillln/sulbactam and cefoperazone/sulbactam, as well as other cephalosporins, demonstrated high activity against methicillin-susceptible staphylococci and penicillin-susceptible pneumococci. B-lactams/beta-lactamase inhibitor combinations were active against 100% strains of anaerobic bacteria.     

产吲哚金黄杆菌培养阳性患者的临床特点及耐药性分析

目的 分析本院送检标本培养出产吲哚金黄杆菌患者的临床特点及耐药情况。方法 采集2013年11月—2017年10月本院住院部所有标本培养出产吲哚金黄杆菌的患者49例的病历资料进行回顾性分析；采集2008年1月—2017年10月本院住院部所有产吲哚金黄杆菌培养阳性标本249例的药敏结果，选取非重复的122例进行耐药性分析。结果 49例患者均伴有严重基础疾病，送检前均使用过广谱抗生素，其中43例有侵入性操作，39例曾入住重症监护室(Intensive Care Unit, ICU)，仅复方磺胺甲噁唑(甲氧苄啶/磺胺甲噁唑)体外耐药率＜50%。结论 (1)本院分离的产吲哚金黄杆菌呈现多重耐药；(2)临床检出产吲哚金黄杆菌的患者多存在严重基础疾病、有广谱抗生素使用史、侵入性操作史、入住ICU史；(3)产吲哚金黄杆菌毒力较弱，本院常见定植。     

儿童社区和院内获得性肺炎的病原菌检查及耐药性分析

目的探讨儿童社区获得性肺炎（CAP）与院内获得性肺炎（HAP）细菌病原构成及耐药性的差异,给临床提供参考。方法对本院2010年6月～2011年5月收治的CAP患儿120例,HAP患儿80例,均进行痰细菌学培养及致病菌耐药性分析。结果 120例CAP患儿共培养细菌134株,细菌构成前5位分别为肺炎链球菌、流感嗜血杆菌、肺炎克雷伯菌、卡他莫拉菌、金黄色葡萄球菌;80例HAP患儿共培养细菌94株,细菌构成前5位分别为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌;HAP患儿中大肠埃希菌耐药率与CAP无明显差异（P〉0.05）,HAP中肺炎克雷伯菌对头孢他啶、头孢吡肟、氨曲南、头孢哌酮、庆大霉素、SMZ＋TMP耐药率远高于CAP（P〈0.05）;HAP阴沟肠杆菌对庆大霉素、SMZ＋TMP、头孢哌酮舒巴坦耐药率明显高于CAP（P〈0.05）;HAP铜绿假单胞菌对头孢他啶、头孢吡肟、氨曲南、头孢哌酮、庆大霉素耐药率明显高于CAP（P〈0.05）;HAP鲍曼不动杆菌对头孢他啶、氨曲南、头孢哌酮、庆大霉素、SMZ＋TMP耐药率明显高于CAP（P〈0.05）。结论肺炎链球菌、流感嗜血杆菌在CAP致病最多,肺炎克雷伯菌、大肠埃希菌在HAP致病最多,并且HAP致病菌耐药率高于CAP。     

Results from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Programme: report of the 2001 data from 15 United States medical centres

The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Programme is an international surveillance network of more than 100 medical centres where meropenem is the primary therapeutic carbapenem. Institutions have been monitored since 1997 (1999 in United States (US)) using National Committee for Clinical Laboratory Standards (NCCLS) reference susceptibility methods to monitor in vitro activity of meropenem and selected other broad-spectrum antimicrobial agents. In 2001, a total of 2874 strains were processed from the 15 US medical centres. Molecular methods were associated with MIC methods as needed for defining epidemic spread of resistant strains. The meropenem MIC(90) values were 0.03 mg/l for Citrobacter spp., Escherichia coli and Klebsiella spp.; 0.06 mg/l for Proteus mirabilis and Serratia spp. and 0.12 mg/l for Enterobacter spp. This potency was 8-16-fold greater than that of imipenem and the meropenem spectrum of activity versus the Enterobacteriaceae was the broadest of all tested antimicrobial agents. Only piperacillin/tazobactam (MIC(9), 64 mg/l) and tobramycin (MIC(90), 4 mg/l) were active against more than 90.0% of Pseudomonas aeruginosa at the NCCLS susceptible breakpoint, and the carbapenems were the most active compounds against Acinetobacter spp. However, Acinetobacter spp. isolates were resistant to all of the antimicrobial agents tested and the molecular typing results suggested that they were epidemiologically related. Only ciprofloxacin and ceftazidime had significantly reduced activity against oxacillin-susceptible staphylococci (87.9-92.6% susceptible. These 2001 US MYSTIC Programme results demonstrated no significant decline in carbapenem activity or susceptibility rates compared with the previously monitored years (1999-2000). Most apparent were the decreasing susceptibility rates for ciprofloxacin and ceftazidime against staphylococci. Continued surveillance in these institutions appears warranted as sites of high potential emerging resistance risk.