革兰阴性杆菌耐药性变迁

目的 :了解上海地区临床分离的革兰阴性杆菌的耐药情况。方法 :2 0 0 1年 1月至 12月上海 11家医院临床分离菌用Kirby Bauer法进行药敏试验。结果 :13934株革兰阴性菌中肠杆菌科细菌 86 86株 ,非发酵革兰阴性杆菌 5 2 4 8株 ,最常见的菌种依次为大肠埃希菌、克雷伯菌属、铜绿假单胞菌、不动杆菌属与肠杆菌属等。与历年比较 ,非发酵革兰阴性杆菌有逐年增多趋势 ,其中嗜麦芽窄食单胞菌也有逐年增多趋势。细菌对临床常用抗菌药物的耐药率较上一年略有增高。对肠杆菌科细菌的作用依次为亚胺培南 (IMP)、美罗培南 (MEM ) >头孢吡肟 (FEP) >头孢哌酮 舒巴坦 (CPZ SBT)、哌拉西林 三唑巴坦(PIP TAZ)、阿米卡星 (AMK) >头孢他啶 (CAZ) >环丙沙星 (CIP) ;对非发酵革兰阴性杆菌的作用依次为IMP、MEM >CPZ SBT、PIP TAZ >CAZ、CIP >FEP、AMK。IMP与MEM对革兰阴性杆菌的抗菌作用基本相同。CPZ SBT和PIP TAZ对肠杆菌科细菌的作用相近 ;非发酵革兰阴性杆菌对两者的敏感性相同 ,但对PIP TAZ耐药的菌株数较多。结论 :本研究结果对革兰阴性杆菌感染的经验用药有重要参考价值

Changing pattern of bacterial resistance in Gram negative bacilli

Objective: To investigate the bacterial resistance of Gram negative bacilli isolated from eleven Shanghai hospitals. Methods: Antimicrobial susceptibility of clinical isolates were tested by Kirby Bauer method. ESBLs of these isolates were detected by method recommended by NCCLS 1999. Results: Of 13?934 Gram negative bacilli, 8?686(62.3%) were Enterobacteriaceae, 5?248(37.7%) were non fermentative bacilli. The most common species were E. coli , Klebsiella spp, P. aeruginosa , Acinetobacter spp and Enterobacter spp. etc. Among them, strains of non fermentative bacilli especially strains of S. maltophilia were increasing in recent years. The resistant rates of different species were slightly higher than those of last year. The antibacterial activity of antimicrobial agents tested against Enterobacteriaceae strains were IMP, MEM>FEP>CPZ SBT, PIP TAZ, AMK>CAZ>CIP, while the activity against nonfermenters were IMP, MEM>CPZ SBT, PIP TAZ>CAZ, CIP>FEP,AMK. IMP is as active against Gram negative bacilli as MEM. Strains of Enterbacteriaceae were as susceptible to CPZ SBT as to PIP TAZ, the susceptibility of non fermentative Gram negative organisms to CPZ SBT was similar to that of PIP TAZ, however, the number of strains resistant to PIP TAZ were more than those resistant to CPZ SBT. Conclusion: Our data may have great significance in the empirical use of antimicrobial agents for the treatment of infections caused by Gram negative bacilli.