北京地区2家医院临床分离革兰阴性菌对头孢哌酮/舒巴坦的耐药性特征研究

摘要：目的 探讨头孢哌酮/舒巴坦对不同部位临床分离革兰阴性菌的耐药特点，为临床治疗选择提供依据。方法 回顾 分析北京两家医院2017年1月-2020年12月的耐药监测数据，使用Whonet 5.6软件分析不同感染部位的病原菌特点及头孢哌酮/ 舒巴坦对常见革兰阴性菌的耐药率，并与其他β-内酰胺类抗生素、酶抑制剂合剂以及常用抗生素的耐药率进行比较，CHISS统 计学软件对结果进行统计学分析。结果 泌尿道感染、血流感染及腹腔感染的病原菌以大肠埃希菌占绝对优势分别为56.5%、 36.5%和40.2%，而中枢神经系统感染以鲍曼不动杆菌为主(31.9%)；临床常见病原菌对头孢哌酮/舒巴坦整体耐药率：大肠埃希 菌11.9%(37/310)、铜绿假单胞菌24.1%(71/295)、肺炎克雷伯菌24.6%(70/285)和鲍曼不动杆菌51.2%(348/680)；对临床治疗棘手 的MDR鲍曼不动杆菌、铜绿假单胞菌、产超广谱β-内酰胺酶大肠埃希菌、肺炎克雷伯菌及碳青霉烯类耐药大肠埃希菌和肺炎克 雷伯菌的耐药率分别为：62.7%(256/409)、46.4%(55/119)、19.3%(30/155)、52.7%(71/135)、73.3%(6/8)和94.7%(59/62)，耐药率 均显著低于第三代头孢菌素及其他加酶抑制剂复合抗生素(P＜0.05)；研究的4种革兰阴性病原菌近4年对头孢哌酮/舒巴坦耐药率 增高明显。结论 临床常见革兰阴性病原菌不同菌种间对头孢哌酮/舒巴坦耐药率差异较大，可作为泌尿道感染、血流感染、腹 腔感染及脑脊液感染经验用药的首选；但需加强监测，采取策略防止其耐药率的快速上升。

Drug resistance characteristics of cefoperazone/sulbactam against clinical Gram-negative bacteria in two Beijing hospitals

Abstract Objective To investigate the drug resistance characteristics of cefoperazone/sulbactam to clinically isolated Gram-negative bacteria from different sources, and to provide evidence basis for clinic treatment. Methods Drug resistance monitoring data of two hospitals in Beijing from January 2017 to December 2020 were retrospectively analyzed. The pathogenic characteristics of different infection sources and drug resistance rates of cefoperazone/sulbactam against common Gram-negative bacteria were analyzed using Whonet 5.6 software. The drug resistance of cefoperazone/sulbactam was compared with other β-lactamase antibiotics and enzyme inhibitors as well as common antibiotics. The results were statistically analyzed by CHISS statistical software. Results Escherichia coli was the dominant pathogen of urinary tract infection, bloodstream infection and abdominal infection, with percentage of 56.5%, 36.5% and 40.2% respectively, while Acinetobacter baumannii was the dominant pathogen ofcentral nervous system(31.9%). The drug resistance rates of clinically isolated common pathogens to cefoperazone/ sulbactam were 11.9% (37/310) for Escherichia coli, 24.1% (71/295) for Pseudomonas aeruginosa, 24.6%(70/285) for Klebsiella pneumonia and 51.2% (348/680) for Acinetobacter baumannii. The MDR strain was intractable for clinical treatment. For example, the drug resistance rates of Acinetobacter baumannii (MDR), Pseudomonas aeruginosa (MDR), Escherichia coli producing extended-spectrum β-lactamase, Klebsiella pneumoniae producing extendedspectrum β-lactamase, carbapenems resistant Escherichia coli and carbapenems resistant Klebsiella pneumoniae were as follows: 62.7%(256/409), 46.4%(55/119), 19.3%(30/155), 52.7%(71/135)、73.3%(6/8)and 94.7%(59/62). The drug resistance rate of cefoperazone/sulbactam was significantly lower than the third-generation cephalosporin and other enzyme inhibitor compound antibiotics (P＜0.05). The resistance rate of four kinds of pathogens to cefoperazone/sulbactam in recent four years increased significantly. Conclusion Cefoperazone/sulbactam can be used as the first choice for urinary tract infection, bloodstream infection, abdominal infection and cerebrospinal fluid infection. However, monitoring should be strengthened and strategies should be taken to prevent the rapid increase of drug