1999-2003年广东和辽宁地区大肠埃希菌和肺炎克雷伯菌临床分离株耐药性比较分析

目的调查1999-2003年国家细菌耐药性监测网广东和辽宁地区大肠埃希菌和肺炎克雷伯菌临床分离株的耐药性,比较不同来源菌株之间耐药率的差别。方法药物敏感性试验采用纸片扩散法,用WHONET5软件进行结果分析。结果 5年间共收集大肠埃希菌6 816株和肺炎克雷伯菌4 411株。尿液、痰和血液等是大肠埃希菌和肺炎克雷伯菌临床分离株的主要标本来源。1999-2003年广东和辽宁地区大肠埃希菌临床分离株对亚胺培南最为敏感,其次为阿米卡星和头孢他啶。大肠埃希菌临床分离株,广东地区的菌株对头孢噻肟的耐药率最高,2003 年增加到32．0％,两地区分离的大肠埃希菌对环丙沙星的耐药率高于60%。肺炎克雷伯菌临床分离株对亚胺培南最为敏感,其次为头孢吡肟、头孢他啶、阿米卡星和环丙沙星。在1999-2003年间,广东和辽宁地区的肺炎克雷伯菌临床分离株对头孢噻肟和头孢他啶的耐药率逐年增高,环丙沙星的耐药率也有一定程度的增高。广东和辽宁地区产超广谱β内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的检出率逐年增高,2003年广东地区产ESBL 大肠埃希菌和肺炎克雷伯菌的检出率分别为29.6％和30.1％,辽宁地区的检出率分别为18．6％和26．6％。广东和辽宁地区的大肠埃希菌和肺炎克雷伯菌临床分离株头孢噻肟耐药、头孢他啶敏感率明显高于头孢噻肟敏感、头孢他啶耐药率。结论通过不同地区间临床分离株细菌耐药性的比较,了解耐药率间的差别,对于临床合理使用抗菌药物、有效控制耐药菌株的传播具有重要意义。

Study on Antimicrobial Resistance of Escherichia coli and Klebsiella pneumoniae Isolates Collected from Hospitals in Guangdong and Liaoning Regions from 1999 to 2003

Objective To investigate and compare the antimicrobial resistance of Escherichia coli and Kleb siella pneu moniae isolates collected from hospitals in different regions in national surveillance network. Methods Disc diffusion test was used to study the antimicrobial resistance,and WHONET 5 was applied for analysis of the antimicrobial resistance. Results In the period of study from 1999 to 2003, E. coli 6 816 and K. pneumoniae 4 411 were collected from hospitals, most of strains were isolated from sputum, urine and blood. The isolates of E. coli from both regions were most susceptible to imipenem,next to amikacin and ceftazidime. The rate of resistance of the strains of E. coli from Guangdong was higher than the isolates from Liaoning to cefotaxime, and increased to 32.0% in 2003. The resistant rates of the all strains of E. coli were more than 60% Pto ciprofloxacin. K. pneumoniae isolates were also most susceptible to imipenem,next to cefepime ceftazidime,amikacin and cip rofloxacin. From 1999 to 2003 ,the resistant rates of the isolates of K. pneumoniae from Guangdong and Liaoning increased to cefotaxime and ceftazidime,and resistance was increased to ciprofloxacin to some extend. The incidences of extended - spectrum - lactamases ( ESBLs) producing strains gradually increased in the study period. In 2003,the incidences of ESBLs - producing strains of E. coli and K. pneumoniae from Guangdong and Liaoning were 29.6% and 30.1%,and 18.6% and 26.6% , respectively. The rate of cefotaxime-resistant,ceftazi dime - susceptible was higher than that to cefotaxime - susceptible, ceftazidime - resistant in these strains. Conclusions It is important to use rationally antimicrobial agents,control the spread of resistant strains by comparing the antimicrobial resistance of E. coli and K. pneumoniae isolates among the different regions and realize the difference in antimicrobial resistance between two regions.