中国非伤寒沙门菌主要血清型临床分离株耐药特征分析

目的 了解我国临床非伤寒沙门菌主要致病血清型菌株对常用药物的敏感情况、耐药特征及耐药变迁,为临床用药提供参考,为沙门菌感染的预防控制决策提供依据。 方法 利用肉汤微量稀释法测定我国2006-2011年219株包含阿贡纳、韦太夫雷登、山夫登堡3种主要沙门菌血清型临床分离株对14种抗生素的最小抑菌浓度(MIC),依据CLSI 2012版敏感判定标准,判定这些沙门菌对抗生素的敏感及耐药情况。 结果 所有菌株对第四代头孢类抗生素头孢吡肟的敏感率均为100%。对第三代头孢菌素(头孢噻肟、头孢他啶)及氨苄西林、甲氧苄氨嘧啶、复方新诺明、四环素、氯霉素、庆大霉素、环丙沙星的敏感率为97%~99%,对链霉素的敏感率为93.61%, 对萘啶酸的敏感率为91.32%,对磺胺甲恶唑的敏感率最低,为85.39%。受试菌株中对3种及3种以上抗生素耐药菌株8株(耐药率为3.65%),其中阿贡纳沙门菌6株。发现同时对氨苄西林、氯霉素、链霉素、磺胺甲恶唑及四环素(ACSSuT)耐药菌株2株,产超广谱内酰胺酶(ESBLs)菌株1株,均为阿贡纳沙门菌。3种沙门菌对磺胺类药物耐药程度明显不同:阿贡纳沙门菌对磺胺甲恶唑耐药率最高,达35.09%,山夫登堡沙门菌对磺胺甲恶唑的耐药率为14%,而韦太夫雷登沙门菌对磺胺甲恶唑则全部敏感。 结论 3种临床常见非伤寒沙门菌血清型对14种抗生素的敏感性不同,不同血清型沙门菌存在不同程度的耐药及多重耐药现象,但总体上对临床常用抗生素敏感性较高,若临床发生此3种血清型沙门菌急性感染时,可以考虑使用除磺胺甲恶唑外的药物进行前期经验性治疗。

Drug resistance of major Salmonella of different serotypes other than Salmonella typhoid in China

Objective To understand the common antibiotic resistance of major Salmonella of different serotypes other than Salmonella typhoid in China and provide reference for the clinical antibiotic use and evidence for the prevention and treatment of Salmonella infection. Methods The drug susceptibility test of 219 Salmonella strains, including S. agona, S. weltevreden and S. senftenberg strains isolated in China from 2006-2011 to 14 antibiotics was conducted with broth microdilution method, the minimum inhibition concentration was obtained and interpreted according to CLSI standard. Results All the isolates were sensitive to the 4th generation cephalosporin. The sensitive rates to several antibiotics, including the 3rd generation cephalosporins (cefotaxime, ceftazidime), ampicillin, ciprofloxacin, trimethoprim, chloramphenicol and tetracycline, ranged from 97% to 99%. The sensitive rates to streptomycin and nalidixic acid were 93.61% and 91.32% respectively. The sensitive rate to sulfamethoxazole was 85.39%. Eight isolates were resistant to multi antibiotics, in which 6 belonged to S. agona, two showed ACSSuT resistance and 1 produced extended spectrum beta-lactamase. The drug susceptibility of 3 serotype Salmonella to sulfamethoxazole was significantly different (35.09% resistant in S. agona, 14% resistant in S. senftenberg and 100% sensitive in S. weltevreden). Conclusion The three serotypes of Salmonella showed different resistance to 14 tested antibiotics and the drug resistance and multi-drug resistance varied among these strains, but the overall sensitive rate to 14 antibiotics was high, indicating the empirical treatment could be conducted with common antibiotics except sulfamethoxazole when acute infection with Salmonella occurred.