2008年某院临床分离的常见细菌耐药性监测

目的调查包头医学院第一附属医院2008年临床分离常见细菌对常用抗菌药物的耐药情况。方法收集2008年1～12月临床分离的常见细菌,采用纸片扩散法进行抗菌药物敏感性试验,数据用WHONET5.4进行统计分析。结果 720株临床分离细菌中,其中革兰阳性球菌165株(22.9%),革兰阴性杆菌555株(77.1%)。革兰阳性球菌中前3位分别是肠球菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌。革兰阴性杆菌前3位分别是大肠埃希菌、铜绿假单胞菌、克雷伯菌属。耐甲氧西林金黄色葡萄球菌检出率为45.5%,耐甲氧西林凝固酶阴性葡萄球菌检出率为52.6%。未检出耐糖肽类抗菌药物的革兰阳性球菌。大肠埃希菌和克雷伯菌属中产超广谱β-内酰胺酶(ESBLs)菌株检出率分别为59.1%、53.9%;产ESBLs菌株耐药率均高于非产ESBLs菌株。其他肠杆菌对多数抗菌药物耐药率较高。非发酵糖革兰阴性杆菌的耐药率均较高。结论临床常见病原菌以革兰阴性杆菌为主,革兰阳性球菌对糖肽类抗菌药物耐药率最低;肠杆菌科细菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率较低。     

糖尿病足湿性坏疽多重耐药菌耐药特点分析

目的探讨糖尿病足湿性坏疽多重耐药菌的分布特点及耐药情况。方法选择2010年1月至2014年12月该院脉管炎科及糖尿病科送检的糖尿病足湿性坏疽患者分泌物1 845份,分离多重耐药菌,分析其分布情况及革兰阴性菌、革兰阳性菌、厌氧菌、真菌的多重耐药特点。结果分离出465株多重耐药菌株中,革兰阴性杆菌274株(58.92%),革兰阳性球菌191株(41.08%)。革兰阴性多重耐药菌株中以大肠埃希菌株为主占37.60%,革兰阳性多重耐药菌株中以凝固酶阴性葡萄球菌为主占51.30%;多重耐药阴性杆菌中,产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌及肺炎克雷伯菌、鲍曼溶血不动杆菌、铜绿假单胞菌表现高耐药性,耐药率达到50.00%以上;多重耐药阳性球菌中,凝固酶阴性葡萄球菌及金黄色葡萄球菌均为耐甲氧西林阳性菌株,这些菌株表现高耐药性,耐药率达85.00%以上。结论糖尿病足湿性坏疽多重耐药菌中大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌及金黄色葡萄球菌表现高耐药性,临床应结合耐药鉴定分析选择用药。     

老年细菌性阴道炎患者致病菌分布与耐药性调查与分析

目的 分析老年细菌性阴道炎患者致病菌分布及耐药现状,为临床治疗提供依据.方法 回顾性分析2008～2010年于本院确诊的老年细菌性阴道炎患者送检的阴道分泌物标本致病菌分离、培养、鉴定及药敏试验结果.结果 主要病原菌依次为凝固酶阴性葡萄球菌(26.2%)、金黄色葡萄球菌(22.8%)、大肠埃希菌(20.5%)、肺炎克雷伯菌(14.7%)和屎肠球菌(12.1%).耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为46.8%、35.2%;超广谱β内酰胺酶(ESBLs)阳性大肠埃希菌和肺炎克雷伯菌分别为23.9%、23.5%.葡萄球菌对青霉素、红霉素耐药率较高,屎肠球菌对青霉素耐药率相对较低;MRSA、MRCNS及ESBLs阳性大肠埃希菌和肺炎克雷伯菌多药耐药现象严重.结论 革兰阳性球菌为老年细菌性阴道炎主要致病菌,其中肠球菌耐药性较轻,革兰阴性杆菌检出率相对较低.     

深圳地区泌尿系统感染的病原菌分布及耐药性分析

目的了解该院泌尿系统感染病原菌的菌群分布及耐药情况,为临床合理选用抗生素、控制医院内尿路感染提供依据。方法分离123株尿培养阳性的病原菌进行鉴定及药敏试验,同时对杆菌进行超广谱β-内酰胺酶(ESBLs)的检测,对葡萄球菌属做甲氧西林耐药检测的筛选。结果病原菌分布为大肠埃希菌61.79%、金黄色葡萄球菌8.94%、凝固酶阴性葡萄球菌6.50%;产ESBLs的大肠埃希菌、肺炎克雷伯菌的检出率分别为26.32%和22.22%;耐甲氧西林金黄色葡萄球菌(MR-SA)、凝固酶阴性葡萄球菌(MRCONS)的检出率分别为54.55%和50.00%。结论临床医师应重视尿路感染病原菌及其耐药性检测,控制医院内尿路感染,合理使用抗生素。     

2125份血液标本细菌培养及耐药性分析

目的：分析住院患者血培养标本中病原菌的分布及耐药性,以便指导用药,提高诊疗效果。方法对2012年11月至2014年11月日照市中医医院2125份血液标本的细菌培养及药敏结果进行分析。结果共分离病原菌233株,阳性率为10.96%;其中革兰阳性球菌57株,占24.46%;革兰阴性杆菌174株,占74.68%。革兰阳性球菌以凝固酶阴性葡萄球菌和金黄色葡萄球菌为主,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为84.2%、40.0%,凝固酶阴性葡萄球菌和金黄色葡萄球菌对青霉素、红霉素、克林霉素的耐药率均不低于80.0%;革兰阴性杆菌以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主,产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌检出率分别为35.85%、28.13%,大肠埃希菌和肺炎克雷伯菌对亚胺培南的敏感率均为100.0%。结论该院病原菌以革兰阴性杆菌为主,具有多重药耐药性,因此应及时送检血培养,指导临床合理用药。     

下呼吸道感染病原菌分布及耐药性监测

目的:了解吉林省油田总医院下呼吸道感染病原菌分布及耐药性.方法:收集该院痰标本865例,进行常规细菌培养及药敏试验.结果:痰培养共分离出582株细菌,阳性率为67.3%,主要分离菌为铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌和葡萄球菌.大肠埃希菌产ESBLs菌阳性率为42.3%,肺炎克雷伯菌为48.6%,产与非产ESBLs菌株的耐药率比较,除庆大霉素对大肠埃希菌无统计学意义外,其他测试抗菌药物对大肠埃希菌和肺炎克雷伯菌的耐药率差异有统计学意义(P<0.01).耐甲氧西林葡萄球菌检出率较高,凝固酶阴性葡萄球菌为50.1%.金黄色葡萄球菌为65.3%.所有分离菌株对常用抗菌药物的耐药性检测结果显示抗菌药物的多重耐药现象严重.结论:痰培养的病原菌以革兰阴性杆菌为主,革兰阴性杆菌对亚胺培南和阿米卡星的耐药率最低:未发现万古霉素和替考拉宁耐药的葡萄球菌;病原菌多重耐药现象严重.     

2009～2011年血流感染病原菌分布及耐药性分析

目的探讨2009～2011年我院血流感染病原菌的分布及耐药性以指导用药。方法收集我院2009年1月至2011年12月血培养标本进行分离、培养、鉴定,采用纸片扩散法(Kirby-Bauer法)进行药敏试验,按CLSI2010年公布的标准判断结果。结果共收集近3年血流感染病原菌871株,其中革兰阳性菌528株,占60.62%,革兰阴性菌317株,占36.39%,真菌26株,占2.99%,居前4位的分别是凝固酶阴性葡萄球菌(CNS)、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分别占金黄色葡萄球菌和CNS的60.98%和88.60%,产超广谱β内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌分别占大肠埃希菌和肺炎克雷伯菌的61.90%和25.71%。结论血培养中以革兰阳性菌,尤其是CNS占重要地位。细菌耐药情况严重,及时监测细菌耐药情况以指导临床用药。     

细菌性腹膜炎病原菌分布及其耐药性分析

目的分析细菌性腹膜炎病原菌分布及耐药状况。方法用phoenixTM100细菌鉴定及药敏分析仪对113株腹膜炎患者腹水中分离的病原菌进行菌株鉴定和药敏试验。结果在分离的113株细菌中,革兰阴性杆菌、革兰阳性球菌及真菌分别占56.6%、39.9%和3.5%;革兰阴性菌中以大肠埃希菌占绝对优势（23.0%）,革兰阳性菌中以凝固酶阴性葡萄球菌占绝对优势（15.9%）。产超广谱β-内酰胺酶（ESBLs）的大肠埃希菌和肺炎克雷伯菌分别占该种细菌的53.8%和36.4%;耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）占凝固酶阴性葡萄球菌的88.9%,耐甲氧西林金黄色葡萄球菌（MRSA）占金黄色葡萄球菌的57.1%。药敏试验表明细菌性腹膜炎的病原菌表现为较高的耐药率及多重耐药性。结论细菌性腹膜炎的病原菌耐药性严重,及时监测病原菌的变迁和耐药发展趋势以指导临床用药至关重要。     

血培养病原菌的分布及耐药性分析

目的 了解血液标本培养中病原菌的分布及耐药情况,以指导临床合理用药.方法 收集2008年1月至2009年12月我院血培养标本3277份,采用Bactec 9120型全自动血培养仪进行培养,MicroScan全自动微生物鉴定仪进行鉴定和药敏试验,采用WHONET 5.4软件进行结果分析.结果 3277份血培养标本中分离出病原菌452株,阳性率13.8％.其中革兰阳性菌221株,占48.9％,革兰阴性菌198株,占43.8％,真菌33株,占7.3％.最常见的病原菌分别是凝固酶阴性葡萄球菌（coagulase negative Staphylococcus,CNS）116株（25.7％）、大肠埃希菌88株（19.5％）、金黄色葡萄球菌（Staphylococcus aureus,SA）44株（9.7％）.88株大肠埃希菌检出产ESBLs菌30株,产酶率为34.1％;36株肺炎克雷伯菌检出产ESBLs菌8株,产酶率为22.2％.SA、CNS对青霉素、苯唑西林、红霉素、克林霉素和复方新诺明的耐药率较高,均大于45.0％;未发现对万古霉素、替考拉宁耐药的革兰阳性菌株;大肠埃希菌、肺炎克雷伯菌对亚胺培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星的敏感性较好,耐药率均小于20.0％.结论 血培养病原菌种类复杂,耐药率高,临床医生应及时监测病原菌的变化及耐药趋势,采取合理的抗菌治疗,控制院内感染.     

2005年上海华山医院细菌耐药性监测

目的了解上海华山医院2005年临床分离菌对各类抗菌药物的耐药性。方法纸片扩散法(Kirby-Bauer法)检测临床分离菌对各类抗菌药物的敏感性,判断标准参照2005年版CLSI文件。结果临床分离3896株细菌中,革兰阴性菌占68.1%,革兰阳性菌占31.9%。金葡菌和凝固酶阴性葡萄球菌中耐甲氧西林株分别占93.2%(465/499)和95.2%(260/273)。未发现万古霉素耐药株。粪肠球菌和屎肠球菌对高浓度庆大霉素耐药率分别为67.4%和82.8%。发现2株耐万古霉素屎肠球菌,均为VanA型耐药。大肠埃希菌产ESBLs株检出率47.6%(206/433),肺炎克雷伯菌和产酸克雷伯菌中产ESBLs株为69.6%(391/562)。各种肠杆菌科细菌对亚胺培南、美罗培南仍高度敏感,除柠檬酸杆菌属对两者的耐药率均为9.1%外,其余均在0～4%之间。铜绿假单胞菌对上述碳青霉烯类的耐药率分别为39.3%和56.9%。结论甲氧西林耐药葡萄球菌(MRSA和MRCNS)、大肠埃希菌和克雷伯菌属中产ESBLs菌株的检出率高,发现2株糖肽类耐药的屎肠球菌。开展细菌耐药性监测,对指导本单位合理选用抗菌药具重要参考价值。     

2002年昆明地区临床分离菌的耐药性监测及分析

目的：通过监测数据了解昆明地区常见临床分离菌的耐药现状，观察细菌耐药性变迁，为临床合理使用抗生素提供依据。方法：对云南省昆明市4所三级甲等医院2002年1月-2002年12月31日临床标本中首次共分离的4927株菌，按美国国家临床实验室标准委员会(NCCLS)2002年版中的K—B法进行药物敏感试验及判断结果，利用WHONET5软件进行统计分析。结果：4927株菌中革兰阳性菌1485株，占30．1％，革兰阴性菌3442株，占69．9％。最常见的细菌依次为大肠埃希菌、凝固酶阴性葡萄球菌、铜绿假单胞菌、克雷伯菌属、粪肠球菌和不动杆菌属等。其中甲氧西林耐药金黄色葡萄球菌(MR—SA)为36．3％(81／233)，甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)为72．6％(522／719)，未发现耐万古霉素的粪肠球菌及金黄色葡萄球菌。大肠埃希菌中产超广谱p内酰胺酶(ESBLs)菌株占37．9％(477／1258)，克雷伯菌属占36．3％．(142／391)．产酶株对抗生素的耐药率均高于非产酶株。易产诱导酶的柠檬酸杆菌、肠杆菌属、沙雷菌属对氨苄西林、阿莫西林一克拉维酸的耐药率较高，约为78．6％～94．7％，而对第三、四代头孢菌素较为敏感。不动杆菌属、铜绿假单胞菌对多种抗生素耐药。结论：昆明地区临床细菌耐药性严重．故根据药敏试验结果合理使用抗生素和控制感染，在防治耐药菌的传播上是非常重要的。     

2010年CHINET克雷伯菌属细菌耐药性监测

目的了解2010年中国CHINET所属14所医院临床分离克雷伯菌属细菌的耐药情况。方法采用纸片扩散法(K-B法)或自动化仪器对临床分离株作药敏试验,并按CLSI 2010年版标准判断药敏试验结果。结果临床分离的肺炎克雷伯菌5 032株和产酸克雷伯菌429株,其中<18岁患者分离的克雷伯菌属细菌占19.4%(1 058/5 461)。62.4%分离株来源于呼吸道标本。药敏试验结果显示,克雷伯菌属对亚胺培南、美罗培南和厄他培南3种碳青霉烯类抗生素的耐药率分别为8.9%、8.9%和10.7%,对头孢哌酮-舒巴坦和哌拉西林-他唑巴坦的耐药率分别为14.8%和16.7%。所有14所医院均分离出对1种以上碳青霉烯类抗生素耐药菌株,其中肺炎克雷伯菌508株,产酸克雷伯菌31株。221株肺炎克雷伯菌和1株产酸克雷伯菌为泛耐药株,主要集中于2所医院(共188株)。结论克雷伯菌属细菌对碳青霉烯类抗生素、头孢哌酮-舒巴坦和哌拉西林-他唑巴坦仍保持良好的敏感性。按CLSI 2010年版标准,肺炎克雷伯菌和产酸克雷伯菌对碳青霉烯类抗生素耐药菌株的分离率分别为10%和7.2%,且耐药株主要集中于2所医院,加强医院感染控制,防止此类耐药菌株在医院内播散至关重要。     

广州地区下呼吸道感染常见病原菌的分布与耐药性

目的 :探讨广州地区下呼吸道感染常见病原菌分布与耐药情况。方法 :收集广州地区 13所医院下呼吸道感染患者痰标本分离的 1778株病原菌 ,按美国国家临床实验室标准委员会 (NCCLS)标准进行药敏试验。结果 :主要菌群有铜绿假单胞菌 (2 2 .7% )、克雷伯菌属 (15 .8% )、不动杆菌属 (12 .5 % )和肠杆菌属 (10 .5 % )等。甲氧西林耐药株分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的 75 .7%和 92 .9% ,未发现万古霉素耐药株。大肠埃希菌和克雷伯菌属产超广谱 β内酰胺酶 (ESBLs)的发生率是 4 6 .8%和 37.0 % ,产ESBLs菌株对各种抗菌药物的耐药率明显高于不产ESBLs菌株。铜绿假单胞菌对头孢哌酮 舒巴坦、头孢他啶、头孢吡肟和亚胺培南的敏感率较高。结论 :广州地区下呼吸道感染主要病原菌是革兰阴性杆菌 ,其对常用抗菌药物耐药性较高 ,开展细菌耐药性监测十分重要。     

Evaluation of antimicrobial activity of beta-lactam antibiotics by Etest against clinical isolates from 100 medical centers in Japan (2004)

This antimicrobial resistance surveillance study was performed in 100 medical centers. The susceptibility of 9347 strains including Escherichia coli (997 strains), Klebsiella spp. (997 strains), Enterobacter spp. (988 strains), Citrobacter spp. (834 strains), indole-positive Proteae spp. (855 strains), Serratia spp. (925 strains), Acinetobacter spp. (902 strains), Pseudomonas aeruginosa (996 strains), oxacillin-susceptible Staphylococcus aureus (992 strains), and coagulase-negative staphylococci (861 strains) to 7 beta-lactam antibiotics, cefepime, cefpirome, ceftazidime, cefoperazone/sulbactam, imipenem and piperacillin (for gram negatives), or oxacillin (for gram positives) was tested. No strain resistant to these beta-lactams except for ceftazidime was found in oxacillin-susceptible S. aureus and coagulase-negative staphylococci. E. coli (16.5%) clinical isolates were resistant to piperacillin, whereas 1.5% or less (cefpirome = 1.5%) was resistant to other beta-lactams. Klebsiella spp. strains were more susceptible to imipenem (99.7%), cefepime (98.4%), and cefpirome (97.3%). Isolates of Enterobacter spp., Citrobacter spp., indole-positive Proteae, and Serratia spp. were susceptible to imipenem, cefepime, and cefpirome, as well. Acinetobacter spp. strains were most susceptible to cefoperazone/sulbactam (0.8% resistance), imipenem (3.2%), ceftazidime (6.0%), and cefepime (7.0%) than other beta-lactam antibiotics tested. Isolates of P. aeruginosa were more susceptible to ceftazidime (9.9% resistance), cefoperazone/sulbactam (14.9%), and cefepime (11.2%) than piperacillin (15.5%), cefpirome (19.1%), and imipenem (19.3%). The percentage of imipenem-resistant P. aeruginosa is around 20% in clinical isolates in Japan.     

2012年武汉同济医院细菌耐药性监测

目的分析武汉同济医院2012年临床分离菌对常用抗菌药物的耐药情况。方法采用纸片扩散法（K—B法）进行抗菌药物敏感性试验,E试验检测肺炎链球菌对青霉素和头孢曲松及葡萄球菌对万古霉素的最低抑菌浓度（MIC）,用WHONET5．6软件进行数据分析。结果2012年共获非重复临床分离菌8191株,其中革兰阳性菌2815株,占34．4％,革兰阴性菌5376株,占65．6％。门诊患者共分离294株细菌,前5位分离菌依次为大肠埃希菌、铜绿假单胞菌、凝固酶阴性葡萄球菌（CNS）、克雷伯菌属和金葡菌;住院非ICU患者共分离6943株细菌,前5位分离菌依次为大肠埃希菌、金葡菌、不动杆菌属、克雷伯菌属和铜绿假单胞菌;ICU患者共分离954株细菌,前5位分离菌依次为不动杆菌属、金葡菌、铜绿假单胞菌、肠球菌属和大肠埃希菌。甲氧西林耐药金葡菌（MRSA）和甲氧西林耐药CNS（MRCNS）的检出率分别为58．1％和64．3％。检出对万古霉素和替考拉宁耐药的肠球菌17株,分别为13株屎肠球菌（VanA型）和4株鹑鸡肠球菌（携带VanA和VanC基因）。屎肠球菌对抗菌药物的耐药率均明显高于粪肠球菌（P〈0．05）。检出碳青霉烯类不敏感肠杆菌科细菌94株。儿童组青霉素不敏感肺炎链球菌（PNSP）分离率（18．9％）明显高于成人组（5．0％）;对碳青霉烯类耐药的铜绿假单胞菌和不动杆菌属检出率分别为28．1％和56．3％;流感嗜血杆菌和卡他莫拉菌中B内酰胺酶阳性率分别为41．8％和98．6％。结论本年度分离的病原菌对多数抗菌药物耐药性呈上升趋势,多重耐药情况严重,耐万古霉素肠球菌及多重耐药革兰阴性杆菌,特别是耐碳青霉烯类肠杆菌科细菌亦呈现上升趋势,应引起临床和医院感染控制部门的重视。     

In vitro activity of newer broad spectrum beta-lactam antibiotics against enterobacteriaceae and non-fermenters: a report from Austrian intensive care units. Austrian Carbapenem Susceptibility Surveillance Group.

We compared the in vitro activity of broad spectrum beta-lactam antibiotics against 573 gram-negative isolates (enterobacteriaceae and non-fermenters) collected between November 1996 and May 1997 from 9 laboratories serving intensive care units throughout Austria. MIC's (Minimal Inhibitory Concentration) were obtained with the E-test for meropenem, imipenem, ceftazidime, cefepime, cefpirome and piperacillin/tazobactam. Pseudomonas aeruginosa was the most frequently isolated organism (22%), followed by E. coli (19%), Klebsiella spp. (16%), and Enterobacter spp. (14%). Acinetobacter spp., Proteus spp., Serratia spp., Stenotrophomonas maltophilia, Citrobacter spp., Morganella morganii, Burkholderia cepacia and Salmonella enteritidis were isolated less frequently. Overall meropenem, imipenem and ceftazidime were the most active compounds in vitro, inhibiting 90%, 89%, and 87% of the isolates, respectively. Pseudomonas aeruginosa was inhibited by piperacillin/tazobactam in 89%, by cefepime in 87% and by ceftazidime in 85%. Imipenem, meropenem and cefpirome were less active (79%, 75% and 69% respectively). All E. coli strains were inhibited by meropenem, 99% were inhibited by imipenem, cefepime and cefpirome. Ceftazidime was active against 95% and piperacillin/tazobactam against 92% of E. coli. All Klebsiella spp. were inhibited by meropenem, cefepime and cefpirome. Imipenem inhibited 99% and ceftazidime 98% of the Klebsiella isolates. Piperacillin/tazobactam was active against 95% of Klebsiella spp. In vitro carbapenems are still the most active of all antibiotics tested. The relatively high resistance of Pseudomonas spp. and Acinetobacter spp. to carbapenems reflects the wide use of carbapenems during the last years. However, most bacterial isolates are still sensitive to the tested broad spectrum beta-lactams.     

Evaluation of antimicrobial susceptibility for beta-lactams using the Etest method against clinical isolates from 100 medical centers in Japan (2006)

This antimicrobial resistance surveillance study was performed in 100 medical centers. Susceptibility testing (Etest; AB BIODISK, Solna, Sweden) of 9152 strains including Escherichia coli (991 strains), Klebsiella spp. (1000 strains), Enterobacter spp. (971 strains), Citrobacter spp. (803 strains), indole-positive Proteae spp. (834 strains), Serratia spp. (902 strains), Acinetobacter spp. (874 strains), Pseudomonas aeruginosa (992 strains), oxacillin-susceptible Staphylococcus aureus (984 strains), and coagulase-negative staphylococci (CoNS; 801 strains) was performed with 7 beta-lactams (cefepime, cefpirome, ceftazidime, cefoperazone/sulbactam, imipenem and piperacillin for Gram-negative bacteria, or oxacillin for Gram-positive bacteria). No strain resistance to these beta-lactams (except for ceftazidime) was found in oxacillin-susceptible S. aureus and CoNS. Of the E. coli clinical isolates, 17.1% were resistant to piperacillin, whereas 2.9% or less (cefpirome = 2.9%) were resistant to other beta-lactam agents. Klebsiella spp. strains were more susceptible to imipenem (99.9%), cefepime (99.2%), ceftazidime (98.6%), and cefpirome (98.3%). Isolates of Enterobacter spp., Citrobacter spp., indole-positive Proteae, and Serratia spp. were susceptible to imipenem, cefepime, and cefpirome as well. Acinetobacter spp. strains were least resistant to cefoperazone/sulbactam (0.7% resistance), imipenem (2.6%), cefepime (6.6%), and ceftazidime (7.7%) compared with other beta-lactam antibiotics tested. Isolates of P. aeruginosa were more susceptible to ceftazidime (8.7% resistance), cefoperazone/sulbactam (9.8%), and cefepime (8.9%) than piperacillin (11.9%), cefpirome (16.2%), and imipenem (12.4%). The percentage of imipenem-resistant P. aeruginosa was approximately 13% in clinical isolates in Japan. The proportion of strains resistant to beta-lactam antimicrobials has been decreasing compared with data from 2004, suggesting that reduced consumption of beta-lactams has reflected the decreased rates of resistant bacterial isolates in Japan.     

890株临床分离肠杆菌科细菌分布和耐药性分析

目的 了解中山大学附属东华医院临床分离的890株肠杆菌科细菌的分布及对各类抗菌药物的耐药状况,为临床合理使用抗菌药物提供依据.方法 收集2010年从患者各种临床标本中分离的肠杆菌科细菌,采用K-B法进行药敏试验,用WHONET5.5软件对数据进行分析.结果 890株肠杆菌科细菌中大肠埃希菌456株(51.2%),克雷伯菌属227株(25.5%),肠杆菌属83株(9.3%).肠杆菌科细菌敏感率在80%以上的药物有亚胺培南、美罗培南、阿米卡星和哌拉西林/他唑巴坦等.大肠埃希菌对亚胺培南和美罗培南保持100.0%敏感率.肺炎克雷伯菌、阴沟肠杆菌和奇异变形杆菌对亚胺培南及美罗培南的敏感率均大于90.0%.结论 肠杆菌科细菌对多数常用抗菌药物耐药率呈上升趋势,对碳青霉烯类抗生素仍最敏感.定期进行耐药性监测有助于了解该院细菌耐药性变迁,为临床经验用药提供依据.     

Surveillance for antimicrobial resistance among clinical isolates of gram-negative bacteria from intensive care unit patients in China, 1996 to 2002

The objective is to investigate the trend of antimicrobial resistance among nosocomial gram-negative bacteria isolated from intensive care units in China. From 1996 to 2002, the minimum inhibitory concentrations (MICs) of 8 antibiotics for 10,585 isolates of gram-negative bacteria from 19 hospitals in 7 central cities were determined by Etest. From 1996 to 2002, a marked decrease in the susceptibility of Pseudomonas aeruginosa to imipenem was noticed along the years (81-62%). Percentage of multidrug resistance of strains in P. aeruginosa obviously increased (11.5% in 1996, 20.5% in 2002). Imipenem kept active against Escherichia coli (99.2-100% susceptible), Acinetobacter spp. (97.6-93.5%), Klebsiella spp. (94.9-100%), Enterobacter spp. (89-96%). Resistance to cephalosporins, ciprofloxacin, and cefoperazone/sulbactam was observed, particularly among E. coli to ciprofloxacin (42-25%) and cefotaxime (78-54%) and Enterobacter spp. to ceftazidime (51-44%) and cefotaxime (50-37%). Piperacillin/tazobactam kept stable and active against P. aeruginosa, E. coli, and Klebsiella spp. (80%), with an increasing trend, but not good, in Enterobacter spp. (63-58%). Extended-spectrum beta-lactamase-producing strains in E. coli (28.6-45.7%) and Klebsiella spp. (25.5-34.9%) increased during 2001-2002. There was no significant increase resistance in Enterobacteriaceae isolates and Acinetobacter spp. to imipenem, but it has obviously decreased activity in P. aeruginosa throughout the 7-year period in China. Resistance of tested gram-negative bacteria to most comparator antimicrobials increased at different levels from 1996 to 2002 in China.     

临床胆汁分离细菌培养与药物敏感试验结果分析

目的分析胆道感染病原菌分布和药敏试验结果,为临床合理用药提供依据。方法 2013年4月至2014年9月厦门大学附属第一医院胆汁标本采用法国生物梅里埃公司BacT/ALERT 3D全自动血培养仪及配套的血培瓶进行增菌培养,全自动微生物鉴定药敏分析仪进行细菌鉴定及药敏试验,运用WHONET 5.6软件进行数据统计分析。结果 217例胆道感染患者有35例(16.1%)分离出2种病原菌,其中肠球菌属与肠杆菌科细菌混合感染(19例,54.3%)最常见;共分离出252株非重复菌株,革兰阳性菌83株(32.9%),革兰阴性菌165株(65.5%),真菌4株(1.6%);分离率居前3位为大肠埃希菌、粪肠球菌和肺炎克雷伯菌;最常见的非发酵菌为铜绿假单胞菌和鲍曼不动杆菌。常见肠杆菌科细菌对氨基糖苷类、4代头孢类、碳青霉烯类和哌拉西林/他唑巴坦耐药率低于40.0%,大肠埃希菌对喹诺酮类的耐药率大于50.0%;粪肠球菌和屎肠球菌对万古霉素、利奈唑胺和替加环素的耐药率极低,对高浓度链霉素和高浓度庆大霉素的耐药率均小于30.0%。结论该地区胆道感染常见病原菌为大肠埃希菌、粪肠球菌和肺炎克雷伯菌,肠球菌属和肠杆菌科细菌混合占2种病原菌混合感染很大比例,病原菌对头孢类和喹诺酮类抗菌药物的耐药性日趋严峻。