腹腔感染细菌流行病学调查

目的监测2006年10月至2007年10月我国不同地区14家教学医院分离的腹腔感染病原菌的菌种分布及其体外药物敏感性。方法按设计方案收集来自腹腔感染的病原菌。菌株经中心实验室复核后，采用琼脂稀释法测定10类共29种抗菌药物的最低抑菌浓度（MIC），数据输入WHONET5．4软件进行耐药性分析。结果此次监测收集的腹腔感染病例数为742例，分离出的病原菌为743株，其中革兰阴性菌占76．7％（570／743），革兰阳性菌占23．3％（173／743）。病原菌中分离率位于前5位的分别为大肠埃希菌（38．8％）、肺炎克雷伯菌（10．2％）、铜绿假单胞菌（9．2％）、屎肠球菌（8-2％）和金黄色葡萄球菌（4．4％）。对于所有肠杆菌科菌，敏感率高于90％的抗菌药物包括美罗培南、亚胺培南、替加环素、阿米卡星和他唑西林-三唑巴坦。对产超广谱β-内酰胺酶（ESBLs）的大肠埃希菌和克雷伯菌，敏感性大于90％的药物包括亚胺培南（100％）、美罗培南（100％）、替加环素（100％）和他唑西林-三唑巴坦（91．5％～91．7％）。铜绿假单胞菌中多重耐药菌株的检出率为14．7％，鲍曼不动杆菌为61．3％。金黄色葡萄球菌中耐甲氧西林（MRSA）的发生率为69．7％，所有菌株对替加环素、万古霉素和替考拉宁均敏感。替加环素对所有粪肠球菌和屎肠球菌均保持了100％的敏感率。粪肠球菌中敏感性较高的抗菌药物还有万古霉素（100％）、替考拉宁（100％）和氨苄西林（81．5％）。屎肠球菌中敏感性较高的抗菌药物还有万古霉素和替考拉宁（96．7％）。结论引起腹腔感染的病原菌以革兰阴性菌特别是肠杆菌科菌为主。替加环素、碳青酶烯类、他唑西林-三唑巴坦和阿米卡星对腹腔感染肠杆菌科菌保持了较高的抗菌活性，非发酵的革兰阴性杆菌的耐药性令人担忧。替加环素、万

Epidemiology of pathogens from intra-abdominal infection

Objective To investigate the distribution and in vitro susceptibility of intra-abdominal causing pathogens from 14 teaching hospitals of different regions between Oct. 2006 and Oct. 2007. Methods Isolates were collected from 14 hospitals and reidentificated in central labortory. MIC of 29 antimicrobial agents were determined by agar dilution method. Data were analyzed by WHONET5.4 software. Results Seven hundred and forty-two intra-abdominal infection cases were collected and 743 isolates were acquired. Among them, 76.7%（570/743） were gram-negative and 23.3%（73/743） were gram-positive. The top five species included Escherichia coli（38. 8 %）, Klebsiella pneumoniae（10.2%）, Pseudomonas aeruginosa（9.2%）, Enterococcus faecium （8.2%） and Staphylococcus aureus（4.4%）. Against Enterobacteriaceae, antimicrobial agents with more than 90% susceptibihty included meropenem, imipenem, tigecychne, amikacin and piperacillin-tazobactam. Against ES-BLs-producing E.coli and K.pneumoniae isolates, antimicrobial agents with more than 90% susceptibility included meropenem（100%）, imipenem （100%）, tigecychne（100%） and piperacillin-tazobactam （91.5%-91.7%）. The percentage of multidrug-resistant isolates in P.aeruginosa was 14.71%, while as this value was 61.29% in A.baumannii. The percentage of MRSA in Staphylococcus aureus was 69.7 % and all isolates were susceptible to tigecydine, vancomycin and teicoplanin. All E.faecalis and E.faecium isolates were susceptible to tigecycline. Antimictobial agents with high susceptibihty included vancomycin （100%）, teicoplanin （100%）, ampicillin （81.5%） against E.faecalis and vancomycin, teicoplanin（96.7%） against E.faecium. Conclusions The main intra-abdominal causing pathogens are gram-negative bacilli, especially enterobacteriaceae. Tigecycline, carbapenem, piperacillintazobactam and amikacin remain relatively high activity against Enterobacteriaceae. The resistance situation of non-fermenting pathogens is a worrying problem. Tigecycline, v