医院内感染病原菌及其对抗生素的耐药状况

调查1988年3月～5月我院591例住院病例,发生96例次院内感染,总发病率16.2％。院内感染病原菌中,革蓝氏阴性杆菌占72.9％,革蓝氏阳性球菌占12.9％,念珠菌属占14.1％。院内感染病原菌的耐药性明显高于院外菌株。绿脓杆菌对庆大霉素和羧苄青霉素的耐药率分别为63.6％和54.5％。其它革蓝氏阴性杆菌院内株对常用抗生素如氨苄青霉素、羧苄青霉素、庆大霉素和妥布拉霉素的耐药率分别为82.5％、 67.5％、47.5％和45％。革蓝氏阳性球菌院内株的耐药性也很严重,表葡菌对多种半合成青霉素类、红霉素、复方新诺明甚至万古霉素的耐药率达60％以上。同时分离出耐甲氧西林金葡菌。     

乙基西索米星与庆大霉素、妥布拉霉素和丁胺卡那霉素体外抗菌活性的比较

本文报道乙基西索米星对548株临床分离菌的体外抗菌作用,并与庆大霉素、妥布拉霉素和丁胺卡那霉素进行比较。丁胺卡那霉素对革蓝氏阴性杆菌的作用最强。乙基西索米星对金葡菌和其他革蓝氏阳性球菌(除肠球菌外)具良好抗菌作用,为四种氨基糖苷类抗生素中作用最强者。乙基西索米星对肠杆菌科细菌的作用与妥布拉霉素相似,但较庆大霉素强,为四者之中对绿脓杆菌的作用最差者。对庆大霉素、妥布拉和丁胺卡那霉素耐药的金葡菌中仍有40～86％的菌株对本品敏感,对庆大霉素和妥布拉霉素耐药的革蓝氏阴性杆菌中仍有30～46.8％的菌株对本品敏感。 鉴于临床致病菌对庆大霉素的耐药率逐渐增加,乙基西索米星对于国内临床上耐药革蓝氏阴性杆菌的作用及其机理值得进一步研究。     

感染性心内膜炎病原菌分布及药敏试验结果分析

对我院2013年1月至2017年12月期间收治的36例血培养阳性的感染性心内膜炎患者的病原菌分布及药敏试验结果进行回顾性分析,为临床经验性选用抗菌药物提供参考。36例血培养阳性患者共检出细菌38株,以革兰阳性球菌居多,包括链球菌属20株,葡萄球菌属14株,肠球菌属2株;革兰阴性菌少见。链球菌属对克林霉素、四环素耐药率较高,红霉素、氟喹诺酮类药物次之,对青霉素、氨苄西林、头孢噻肟敏感;葡萄球菌属中共检出苯唑西林9耐药株,青霉素12耐药株,耐苯唑西林及耐青霉素的菌株检出率较高;未见万古霉素、利奈唑胺、替加环素耐药阳性球菌。因此,在经验性治疗感染性心内膜炎时,青霉素类药物首选经验用药需谨慎,万古霉素可作为初始治疗效果欠佳或存在耐药菌感染患者的理想选择药物。     

1330株临床分离革兰阳性菌耐药性分析

目的 了解临床分离的革兰阳性菌对不同抗菌药物的耐药情况,为临床医师及时提供抗生素的耐药动向与耐药变迁为临床抗感染治疗提供选药依据.方法 用苯唑西林检测葡萄球菌临床分离株的敏感性,用纸片扩散法检测革兰阳性菌对四环素、红霉素、庆大霉素、氨苄青霉素、环丙沙星、头孢吡肟、复方磺胺甲噁唑、万古霉素、替考拉宁、利福平、克林霉素等抗菌药物的耐药结果.用E-test法检测对苯唑西林耐药的肺炎链球菌青霉素的MIC值.结果 1330株革兰阳性菌中耐甲氧西林的葡萄球菌对抗菌药物的耐药率显著高于对甲氧两林敏感的葡萄球菌.肠球菌属以粪肠球菌和屎肠球菌检出率最高,粪肠球菌对呋喃妥因、氨苄西林耐药率较低,屎肠球菌耐药性较强,仅对氯霉素、四环素耐药率较低.肺炎链球菌对四环素、克林霉素、红霉素有较高的耐药率,青霉素不敏感肺炎链球菌(PNSSP)的E-test检测结果以中介菌株为主,PNSSP的MIC值最高达到6μg/mL.结论 葡萄球菌、肺炎链球菌对万古霉素全部敏感,有仅发现1株耐万古霉素的屎肠球菌,万古霉素是临床治疗重症革兰阳性菌感染的首选药物.加强耐药性监测对指导临床合理使用抗菌药物具有重要意义.     

医院感染耐甲氧西林金黄色葡萄球菌的耐药性分析

为了解医院感染耐甲氧西林金黄色葡萄球菌(MRSA)的耐药情况,对从住院病人各种临床标本中分离出的金黄色葡萄球菌(sau)进行药敏试验(测MIC),用苯唑青霉素(OX)代替甲氧西林测MRSA.结果共分离出93株MRSA,其中73株属医院感染,其对青霉素类、头孢菌类素及亚胺硫霉素等的耐药率为100%;对庆大霉素、红霉素、四环素、环丙氟哌酸、氯霉素、克林霉素耐药率达50.0%以上;对复方新诺明、利福平耐药率为47.9%、38 .4%;对万古霉素耐药率为0.0%.结论:MRSA对临床常用的抗生素存在高度耐药性,万古霉素是治疗医院感染MRSA的首选药物.     

医院感染耐甲氧西林金黄色葡萄球菌的耐药性分析

为了解医院感染耐甲氧西林金黄色葡萄球菌(MRSA)的耐药情况,对从住院病人各种临床标本中分离出的金黄色葡萄球菌(sau)进行药敏试验(测MIC),用苯唑青霉素(OX)代替甲氧西林测MRSA.结果共分离出93株MRSA,其中73株属医院感染,其对青霉素类、头孢菌类素及亚胺硫霉素等的耐药率为100%;对庆大霉素、红霉素、四环素、环丙氟哌酸、氯霉素、克林霉素耐药率达50.0%以上;对复方新诺明、利福平耐药率为47.9%、38 .4%;对万古霉素耐药率为0.0%.结论:MRSA对临床常用的抗生素存在高度耐药性,万古霉素是治疗医院感染MRSA的首选药物.     

国产利福喷丁对非分枝杆菌病原菌的体外抗菌作用研究

本文研究了国产利福喷丁对29种331株非分枝杆菌病原菌的体外抗菌活性以及它与19种抗生素对30株金葡菌、10株凝固酶阴性葡萄球菌、10株粪链球菌和10株非肠球菌的体外联合抗菌作用。结果表明利福喷丁对8种革蓝氏阳性球菌均具较强抗菌活性,0.5mg/L即可抑制90％的金葡萄(包括耐苯唑青霉素的金葡菌)和凝固酶阴性葡萄球菌的生长,4mg/L可抑制90％的粪链球菌和非肠球菌生长,但略逊于利福定和利福平。利福喷丁与青霉素G、苯唑青霉素、氨苄青霉素、氧哌嗪青霉素,头孢噻啶、头孢唑啉、头孢孟多、头孢噻肟、头孢哌酮、头孢三嗪、Ceftazidime、庆大霉素、丁胺卡那霉素、氯霉素和氟哌酸联合呈明显协同作用,与红霉素、洁霉素、万古霉素和强力霉素联合主要是无关作用,且在少量菌株中表现出拮抗作用。     

万古霉素治疗耐苯唑青霉素金葡菌感染

作者估价了以万古霉素治疗27例耐苯唑青霉素葡萄球菌感染的疗效。受试者均以微生物学证实感染由体外耐苯唑青霉素的金葡菌所致。苯唑青霉素对这些金葡菌的最低抑菌浓度(MIC)均为≥12.5mg/l,所有受试     

血液病患者金葡球菌的耐药性分析

目的：了解西安地区血液病患者金黄色葡萄球菌（金葡球菌）的感染比例、β－内酰胺酶携带率、ＭＲＳＡ分离率及对多种抗生素的耐药性。方法：采用Ｋ－Ｂ法对８２株金葡球菌进行了１８种抗菌药的体外抗菌活性试验,β－内酰胺酶采用Ｏｘｏｉｄ公司生产的ｎｉｔｒｏｃｅｆｉｎ纸片测试,用每片１μｇ的苯唑西林的纸片进行ＭＲＳＡ的筛选试验。结果：血液病患者金葡球菌的感染率为１３．８％,８２株金葡球菌对去甲万古霉素、利福平、头孢哌酮、头孢他啶、妥布霉素的敏感性分别为１００％、９７．１％、８２．９２％、８０．４９％、８０％,金葡球菌对青霉素的敏感率最低为１２．１９％。在８２株金葡球菌中β－内酰胺酶的携带率为７８．２６％,ＭＲＳＡ的检出率为６５．８５％。结论：明确了血液病患者感染的金葡球菌在体外对不同抗菌药的敏感性,对指导临床选择有效抗菌药具有重要意义。     

新生儿败血症病原菌及药敏结果分析

目的:分析新生儿败血症病原菌及其耐药情况,以指导合理应用抗生素。方法:对55例新生儿败血症患儿的标本进行血培养及药物敏感性试验。结果:55株细菌中80%以上为球菌,金葡菌对青霉素、苯唑西林、红霉素的耐药率分别达80.77%、61.54%、57.69%,对头孢呋辛、头孢噻吩、氨苄/舒巴坦耐药率<30%。结论:球菌为本院新生儿败血症的主要致病菌,头孢呋辛、头孢噻吩、氨苄/舒巴坦可作为首选药物。     

Antibiotic resistance of bacterial strains isolated from children in Child Health Center, Warsaw

This study examines the antibiotic susceptibility of 1792 bacterial strains isolated from hospitalized children between January and December 1993. A total of 1015 Gram-negative rods represented by members of Enterobacteriaceae family (770) and nonfermenters (245) were isolated. The most resistant strains were noticed among Klebsiella pneumoniae and Enterobacter cloacae. From 38% to 46% of K. pneumoniae strains were resistant to third-generation cephalosporins, but all of them were sensitive to imipenem. From 60% to 80% of E. cloacae isolates were resistant to all beta-lactams, but sensitive to imipenem. Resistance of P. aeruginosa to aminoglycosides varied from 30% for gentamicin to 5% for amikacin. About 40% of P. aeruginosa strains were resistant to carbenicillin, and 25% to azlocillin and piperacillin, but only two strains were resistant to ceftazidime and imipenem. Among Gram-positive cocci the most frequently encountered were coagulase-negative staphylococci, followed by Staphylococcus aureus and Enterococcus faecalis. The methicillin-resistant strains of coagulase-negative staphylococci and S. aureus consisted 74.8% and 34%, respectively. All strains of methicillin-resistant coagulase-negative staphylococci and S. aureus were sensitive to vancomycin.     

Susceptibilities of bacteria isolated from patients with lower respiratory infectious diseases to antibiotics (1998)

The bacteria isolated from the patients with lower respiratory tract infections were collected by institutions located throughout Japan, since 1981. Ikemoto et al. have been investigating susceptibilities of these isolates to various antibacterial agents and antibiotics, and analyzed some characteristics of the patients and isolates from them each year. Results obtained from these investigations are discussed. In these 18 institutions around the entire Japan, 532 strains of presumably etiological bacteria were isolated mainly from the sputa of 438 patients with lower respiratory tract infections during the period from October in 1998 to September in 1999. MICs of various antibacterial agents and antibiotics were determined against 85 strains of Staphylococcus aureus, 100 strains of Streptococcus pneumoniae, 96 strains of Haemophilus influenzae, 75 strains of Pseudomonas aeruginosa (non-mucoid strains), 6 strains of Pseudomonas aeruginosa (mucoid strains), 38 strains of Moraxella subgenus Branhamella catarrhalis, 26 strains of Klebsiella pneumoniae etc., and the susceptibilities of 517 strains were assessed except for those strains that died during transportation. S. aureus strains for which MICs of oxacillin (MPIPC) were higher than 4 micrograms/ml (methicillin-resistant S. aureus: MRSA) accounted for 60.0%. Vancomycin (VCM) and arbekacin (ABK) showed the most potent activities against MRSA. But one of MRSA showed resistance to ABK with the MIC of 64 micrograms/ml. The sensitive strains of MRSA to VCM have decreased. The frequency of penicillin (PC)-intermediate S. pneumoniae (PISP) + PC-resistant S. pneumoniae (PRSP) have increased in 46.0% for 1998 comparatively from 30.9% of 1997's. But PRSP decreased, and PISP increased into 39.0% of 1998 years from 19.8% of 1997's. Panipenem (PAPM), imipenem (IPM) and faropenem (FRPM) showed the most potent activities against S. pneumoniae with MIC80s of 0.125 microgram/ml or below. Against H. influenzae and M. (B.) catarrhalis, almost all the drugs showed good activities. The sensitive strains of them against ceftazidime (CAZ) decreased in 1997, but those have increased in 1998. Inversely, the susceptibility of them against cefotiam (CTM) had been higher in 1997, but those have been lower in 1998. Tobramycin (TOB) showed the most potent activity against P. aeruginosa (both mucoid and nonmucoid strains). All drugs except ampicillin (ABPC) were active against K. pneumoniae. A quite few of K. pneumoniae showed low susceptibilities. Also, we investigated year to year changes in the characteristics of patients, their respiratory infectious diseases, and the etiology. The examination of age distribution indicated that the proportion of patients with ages over 70 years was 48.6% of all the patients showing a slight increase in every year. About the proportion of diagnosed diseases as follows: Bacterial pneumonia was the most frequent with 40.2%. The ratio of it has increased slightly, and the increased rate was 10% in patients with ages over 70 years compared with the results in 1997. Chronic bronchitis have decreased slightly with 27.6% in 1998. Number of strains isolated from patients before administration of antibiotics were more than those after administration of them in chronic bronchitis, but these were almost same number in bacterial pneumonia. Administration of antibiotics has changed the results of the frequency of isolation of bacterial species. Bacterial isolations before administration of antibiotics were as follows: S. pneumoniae 26.7%, H. influenzae 23.8%, S. aureus 13.3% and M. (B.) catarrhalis 10.8%. The frequencies of S. aureus decreased after antibiotics administration over 15 days, but the frequencies of P. aeruginosa (both mucoid and non-mucoid) was not affected. The frequencies of P. aeruginosa was 45.5% after administration over 15 days. The frequencies of S. pneumoniae decreased upon administration of antibiotics, these were only 4.5% over 15 days. The frequencies of H. (     

Susceptibilities of bacteria isolated from patients with lower respiratory infectious diseases to antibiotics (1997)]

The bacteria isolated from the patients with lower respiratory tract infections were collected by institutions located throughout Japan, since 1981. Ikemoto et al. have been investigating susceptibilities of these isolates to various antibacterial agents and antibiotics, and analyzed some characteristics of the patients and isolates from them each year. Results obtained from these investigations are discussed. In these 17 institutions around the entire Japan, 512 strains of presumably etiological bacteria were isolated mainly from the sputa of 440 patients with lower respiratory tract infections during the period from October in 1997 to September in 1998. MICs of various antibacterial agents and antibiotics were determined against 100 strains of Staphylococcus aureus, 81 strains of Streptococcus pneumoniae, 85 strains of Haemophilus influenzae. 71 strains of Pseudomonas aeruginosa (non-mucoid strains), 27 strains of Pseudomonas aeruginosa (mucoid strains), 33 strains of Moraxella subgenus Branhamella catarrhalis, 17 strains of Klebsiella pneumoniae etc., and the susceptibilities of these strains were assessed except for those strains that died during transportation. S. aureus strains for which MICs of oxacillin (MPIPC) were higher than 4 micrograms/ml (methicillin-resistant S. aureus: MRSA) accounted for 55.0%. The frequency of the drug resistant bacteria decreased comparing to the previous year's 67.3%. Arbekacin (ABK) and vancomycin (VCM) showed the most potent activities against MRSA. Imipenem (IPM) and panipenem (PAPM) of carbapenems showed the most potent activities with MIC80S of 0.063 microgram/ml against S. pneumoniae. The frequency of penicillin (PC)-intermediate S. pneumoniae (PISP)+PC-resistant S. pneumoniae (PRSP) had decreased gradually, that is, in 1995 the frequency of it was 40.3%, but that was 30.9% in 1997. Against H. influenzae and M.(B.) catarrhalis, all the drugs showed good activities. But the sensitive strains of them against ceftazidime (CAZ) had decreased in 1997, compared those in 1995 and 1996. Meropenem (MEPM), IPM and tobramycin (TOB) showed the most potent activity against P. aeruginosa (mucoid strains). And TOB and ciprofloxacin (CPFX) showed the most potent activities against P. aeruginosa (non-mucoid strains). All drugs except ampicillin (ABPC) were more active against K. pneumoniae in 1997 than that in 1996. Also, we investigated year to year changes in the characteristics of patients, their respiratory infectious diseases, and the etiology. The examination of age distribution indicated that the proportion of patients with ages over 70 years was 45.5% of all the patients showing a slight increase year by year. About the proportion of diagnosed diseases, not so particular changes were recognized as follows: Bacterial pneumonia and chronic bronchitis were the most frequent with 33.6% and 29.1%, respectively. Number of strains isolated from patients before administration of antibiotics were more than those after administration of them in chronic bronchitis, but these had reversed in bacterial pneumonia. The tendency in bacterial pneumonia had been acknowledged since 1995. The increase of S. aureus and P. aeruginosa (both mucoid and non-mucoid strains) isolated after administration of antibiotics, has suggested the decrease of the susceptibility of these strains against antibiotics. Administration of antibiotics has changed the results of the frequency of isolation of bacterial species. Bacterial isolations before administration of antibiotics were as follows: S. pneumoniae 24.5%, H. influenzae 21.4%, S. aureus 18.4% and P. aeruginosa 12.2%. The frequencies of S. aureus decreased after antibiotics administration over 15 days, but the frequencies of P. aeruginosa was not affected. The frequencies of P. aeruginosa was 47.8% after administration over 15 days. From patients administered antibiotics of penicillins and cephems. S. aureus was mainly detected with 31.7-58.3%, and from patients administere     

2008年我院感染病原菌的分布及药物敏感性分析

目的分析院内感染病原菌的分布趋势及药物敏感性,为临床合理用药提供依据。方法药物敏感试验采用K—B纸片扩散法,以自行研制的院内感染监控系统软件进行数据统计分析。结果医院临床分离率居前10位的细菌分别为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、白假丝酵母、屎肠球菌、粪肠球菌、阴沟肠杆菌、表皮葡萄球菌。其中耐甲氧西林金黄色葡萄球菌（MRSA）的分离率已达到65．23％,产超广谱β-内酰胺酶（ESBLs）的大肠杆菌和肺炎克雷伯菌分别为58．20％和67．90％,革兰阳性（G^＋）球菌对万古霉素、替考拉宁的敏感率均保持在98％以上;肠杆菌科中大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌、阴沟肠杆菌对亚胺培南的敏感率均在90％以上;非发酵菌中铜绿假单胞菌和鲍曼不动杆菌敏感率最高的是头孢哌酮舒巴坦。结论万古霉素、替考拉宁对G^＋球菌始终保持着高活性,未发现万古霉素耐药的葡萄球菌;碳青酶烯类仍然是对肠杆菌科细菌活性最好的药物;非发酵菌中铜绿假单胞菌和鲍曼不动杆菌的耐药性不断增加,并出现了多重耐药菌株。     

呼吸内科病房病原菌分布及耐药性分析

目的分析呼吸内科病房病原菌的分布特点及其对常用抗菌药物的敏感性和耐药性。方法从2004—2006年我院呼吸内科病房送检痰标本中分离致病菌1599株,采用纸片扩散法(Kirby-Bauer法),按美国临床实验室标准委员会(NCCLS)标准判定敏感菌株并做药敏分析。结果常见病原菌为肺炎链球菌(28.3%)、铜绿假单胞杆菌(9.3%)、鲍曼不动杆菌(7.8%)、大肠杆菌(3.5%)、凝固酶阴性的葡萄球菌(6.4%)及金黄色葡萄球菌(1.4%)。药敏结果:肺炎链球菌、铜绿假单胞杆菌、鲍曼不动杆菌和大肠杆菌对氨苄西林、复方磺胺甲唑的耐药率均达100%,大肠杆菌和肺炎克雷伯杆菌对亚胺培南的敏感率为100%,鲍曼不动杆菌对亚胺培南的敏感率在86.7%以上。铜绿假单胞杆菌对所有的常用抗生素有不同程度耐药,其中对阿米卡星的敏感率在76.2%以上,其次为亚胺培南及美洛培南,敏感率在30%以上。肺炎链球菌、金黄色葡萄球菌及凝固酶阴性的葡萄球菌对青霉素的耐药率达100%,对万古霉素的敏感率达100%。结论革兰阴性杆菌是呼吸内科病房内感染的主要致病菌,细菌耐药问题日益严重,为控制耐药菌株的产生和扩散,抗生素的合理使用和细菌耐药性的监测尤为重要。     

Antimicrobial susceptibilities of organisms isolated from patients with urinary tract infections in 2002

Using the agar dilution method, the antibacterial activity of 18 antibiotics inclusive of 4 carbapenems were investigated against 101 strains of urinary pathogens isolated from patients with urinary tract infections who visited the Department of Urology at Kagoshima University Hospital, between January and December 2002. 4 strains of Staphylococcus aureus, 3 strains of Staphylococcus spp. (exclusive of S. aureus), 14 strains of Enterococcus faecalis, 3 strains of Enterococcus spp. (exclusive of E. faecalis), 41 strains of Escherichia coli, 21 strains of Enterobacteriaceae (exclusive of E. coli), 12 strains of Pseudomonas aeruginosa and 3 strains of glucose-nonfermentative Gram-negative rods (exclusive of P. aeruginosa) were examined. 1. Against clinical isolates of Gram-positive bacteria, vancomycin and teicoplanin were active. Additionally, arbekacin was active against S. aureus clinical isolates and ampicillin was active against E. faecalis clinical isolates. Carbapenems were active against clinical isolates of Gram-positive bacteria, except for multi-drug resistant strains of Gram-positive bacteria, such as methicillin-resistant S. aureus. 2. As for clinical isolates of Gram-negative bacteria, meropenem was most active against Enterobacteriaceae among 13 antibiotics tested. Against P. aeruginosa clinical isolates, MIC90 of meropenem was the lowest among 13 antibiotics tested. In addition, resistant rate of meropenem and biapenem against P. aeruginosa clinical isolates was lower than those of the other carbapenems tested. 3. As main urinary pathogens showed no remarkable increase in resistance to carbapenems, it can be stated that carbapenems retain their position as the drug of first choice for severe infection.     

Studies of isolated organisms from otorhinolaryngological infections and their susceptibilities to macrolide antibiotics

To study current situation of pathogenic bacteria and their drug resistance to macrolide antibiotics in the otorhinolaryngological infections, 609 strains diagnosed as pathogen derived from 463 patients were collected from cohospitals or institutions during the period of 1980-1983. The results obtained were as follows: Gram-positive cocci (GPC) was dominant (410 strains) and major species were S. aureus (135 strains), S. pneumoniae (81 strains), S. epidermidis (68 strains) and S. pyogenes (65 strains). In Gram-negative bacteria giving 147 strains and 43 strains, of anaerobes prevailing species were H. influenzae, P. aeruginosa and Peptostreptococcus spp. Representative species in the diseases were S. aureus (26.6%), S. epidermidis (24.5%), and P. aeruginosa (12.8%) in acute otitis media, S. aureus (34.4%), S. epidermidis (17.7%) and P. aeruginosa (14.6%) in acute exacerbation of chronic otitis media, S. epidermidis (17.0%), S. aureus (16.1%) and H. influenzae (13.4%) in acute paranasal sinusitis, S. pyogenes (29.1%), S. pneumoniae (19.6%) and S. aureus (15.1%) in acute tonsillitis. Although most of isolates were susceptible to macrolides, 62 resistant strains to macrolides were found in 501 strains and the resistant rates were 26.7% in S. aureus, 23.1% in S. epidermidis and 6.5% in S. pyogenes. The resistant pattern was somewhat different against each macrolides, resistant strains giving over 100 micrograms/ml in MIC were 55/62 in erythromycin, 35/62 in josamycin and midecamycin and 7/62 in TMS-19-Q, a new macrolide.     

Isepamicin与六种氨基糖苷类体外抗菌活性研究

本文比较fsepamicin(ISP)、庆大霉素(GM)、地贝卡星(DKB)、乙基西索米星(NTL)、妥布霉素(TOB)、西索米星(SISO)与阿米卡星(AMK)的体外抗菌活性。金葡菌产酶株对上述抗生素的敏感性显较不产酶株为差,以ISP、NTL对金葡菌产酶株的作用最强。其平均MIC值分别为1.85和2.12mg/L;对革兰氏阴性杆菌的作用则以ISP和AMK为强。以ISP对各种细菌的MIC值最低0.32～3.39mg/L。TOB、GM、SISO、NTL与DKB对多数革兰氏阴性杆菌的作用相似,五者之间有很大程度交叉耐药。所测611株革兰氏阴性杆菌中对一种以上药物耐药者312株,占51％;其中对ISP和AMK仍敏感者分别为90.4％和91.7％,而对NTl、GM、TOB、DKB敏感者仅15～18％,本文讨论了细菌对氨基糖苷类的耐药机理及其临床意义。     

Antimicrobial susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Pseudomonas aeruginosa isolated in major hospitals in Nagano prefecture

We determined the minimum inhibitory concentration (MIC) of various antimicrobial agents against 140 strains of Streptococcus pneumoniae, 131 strains of Haemophilus influenzae and 178 strains of Pseudomonas aeruginosa isolated from respiratory organs in 28 affiliated hospitals in Nagano prefecture between December 2002 and February 2003. The results of this report were as followed: 1. All 140 strains of S. pneumoniae were classified into 3 groups; penicillin-susceptible S. pneumoniae (PSSP) (47.1%), penicillin-intermediate S. pneumoniae (PISP) (43.6%) and penicillin-resistant S. pneumoniae (PRSP) (9.3%). 2. Carbapenems and glycopeptide (vancomycin) had highly potent antimicrobial activity against PISP and PRSP like PSSP. However, some of PISP or PRSP isolates were resistant to cephalosporins and a fluoroquinolone (levofloxacin). 3. All 131 strains ofH. Influenzae were also classified into three groups; ampicillin sensitive H. influenzae (73.3%), beta-lactamase producing ampicillin resistant H. influenzae (BLPAR) (8.4%) and beta-lactamase negative ampicillin resistant H. influenzae (BLNAR) (18.3%). 4. Carbapenems and a fluoroquinolone had highly potent antimicrobial activity against BLPAR and BLNAR. However, there were clear differences among 4 carbapenems for the antimicrobial activity. Ceftriaxone (CTRX) was the most active among cepharosporins in this study. 5. The rate of P. aeruginosa isolates resistant to carbapenems, a fluoroquinolone and aminoglycosides were about 11 to approximately 16%, 15% and 0.6 to approximately 8%, respectively. None of the strains was resistant to all 3 antimicrobial classes, but 3 strains were resistant to combination of 2 classes. 6. The MIC50 and MIC90 values of various antibiotics against S. pneumoniae, H. influenzae and P. aeruginosa were different in all 4 regions. In conclusion, the antimicrobial surveillance programs are important for guiding empiric therapy and for focusing interventional control of antimicrobial resistance in regions and hospitals.     

我院527株优势细菌的药敏分析与合理选药

目的 :指导临床合理选用抗生素。方法 :对我院2002年1月～12月分离出的527株优势菌株进行统计分析。结果 :大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌为优势菌中常见菌 ,优势菌中G + 细菌占32 1 % ,G -细菌占67 9 %。其中 ,耐万古霉素的表皮葡萄球菌、屎肠球菌和铅黄肠球菌各1株 ,甲氧西林耐药金黄色葡萄球菌占金葡菌的64 0 % ,甲氧西林耐药表皮葡萄球菌占表葡菌的78 6 % ,甲氧西林耐药溶血性葡萄球菌占溶血性葡萄球菌的70 %。结论 :临床应了解细菌对抗生素的耐药特点 ,合理选用抗生素。