常见革兰阴性杆菌临床分离株对碳青霉烯类等抗菌药物的耐药性分析

目的 调查常见革兰阴性杆菌临床分离株对碳青霉烯类等抗菌药物的耐药性,为临床治疗提供依据。 方法 采用回顾性分析方法,调查2009年1月至2011年12月从温州医学院附属第一医院住院患者分离的2361株革兰阴性杆菌对碳青霉烯类等抗菌药物的耐药性,其中肠杆菌科细菌1832株,非发酵菌529株。 结果 肠杆菌科细菌对碳青霉烯类抗菌药物的耐药较低。大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、产气肠杆菌、粘质沙雷菌、摩根摩根菌和产酸克雷伯菌对亚胺培南的耐药率分别为0.2%(2/1053)、3.0%(15/504)、2.9%(3/102)、9.5%(7/74)、21.7%(10/46) 、10.7%(3/28)和16.0%(4/25);对美罗培南的耐药率分别为0.4%(4/1053)、3.4%(17/504)、3.9%(4/102)、8.1%(6/74)、19.6%(9/46)、14.3%(4/28)和16.0%(4/25)。非发酵菌对碳青霉烯类抗生素的耐药率高,鲍曼不动杆菌、铜绿假单胞菌、洋葱伯克霍尔德菌对亚胺培南的耐药率分别为76.8%(209/272)、37.2%(55/148)和73.4%(80/109);对美罗培南的耐药率分别为73.9%(201/272)、33.8%(50/148)和69.7%(76/109)。肠杆菌科细菌和非发酵菌对其他10种抗生素均呈较高的耐药率。 结论 碳青霉烯类抗菌药物对检测的肠杆菌科细菌具有很好的体外抗菌活性,但对非发酵菌的体外抗菌活性较差。

Carbapenems resistance of frequently isolated clinical gram negative bacilli strains

Objective To understand the antibiotic resistance of frequently isolated clinical gram negative strains and provide evidence for the treatment of clinical infections caused by these bacilli. Methods A total of 2361 frequently isolated gram negative bacilli strains isolated in our hospital from January 2009 to December 2011 were analyzed retrospectively. Of the 2361 isolates, 1832 were Enterobacteriaceae strains, including 1053 Escherichia coli strains, 504 Klebsiella pneumoniae strains, 102 Enterobacter cloacae strains, 74 Enterobacter aerogenes strains, 46 Serratia marcescens strains, 28 Morganella morganii strains and 25 Klebsiella oxytoca strains, 529 were Nonfermentative bacilli strains, including 272 Acinetobacter baumannii strains, 148 Pseudomonas aeruginosa strains and 109 Burkholderia cepacia strains. Results The resistance rates of Enterobacteriaceae strains to impenem and meropenem were as follows: E. coli:0.2% (2/1053) and 0.4% (4/1053); K. pneumoniae:3.0% (15/504) and 3.4% (17/504); E. cloacae: 2.9% (3/102) and 3.9% (4/102); E. aerogenes: 9.5% (7/74) and 8.1% (6/74), S. marcescens: 21.7% (10/46) and 19.6% (9/46); M. morganii: 10.7% (3/28) and 14.3% (4/28); K. oxytoca: 16.0% (4/25) and 16.0% (4/25), respectively. While the resistance rates of A. baumannii, P. aeruginosa and B. cepacia to imipenem and meropenem were 76.8% (209/272) and 73.9% (201/272), 37.2% (55/148) and 33.8% (50/148), and 73.4% (80/109) and 69.7% (76/109), respectively. The resistance rates of tested clinical isolates to other 10 antibiotics were very high. Conclusion Carbapenems have relatively high antimicrobial activity to Enterobacteriaceae in vitro, while low antimicrobial activity to nonfermentative bacilli strains.