重症监护病房革兰阴性杆菌连续六年耐药性监测研究

Surveillance of antimicrobial resistance of gram negative bacterial isolates from patient in intensive care unit during 1998 2003

目的观察和监测重症监护病房常见革兰阴性杆菌对抗菌药物的耐药变化及超广谱β内酰胺酶(ESBL)菌株的发生率。方法连续监测1998～2003年本院重症监护常见革兰阴性杆菌的耐药状况。用E试验法测定547株革兰阴性杆菌对11种抗菌药物的MIC,并用头孢他啶/头孢他啶+克拉维酸和头孢噻肟/头孢噻肟+克拉维酸E试条检测细菌产ESBL的情况。结果大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌和嗜麦芽窄食单胞菌是监护病房常见革兰阴性杆菌。亚胺培南对所有受试菌保持最高抗菌活性,细菌总耐药率仅为804%,肺炎克雷伯菌完全敏感;阿米卡星、头孢哌酮/舒巴坦、头孢他啶、哌拉西林/他唑巴坦和头孢吡肟有较高抗菌活性,耐药率分别为185%、207%、208%、214%和256%,其他抗菌药物耐药率在422%～516%之间。筛选大肠埃希菌和肺炎克雷伯菌ESBL产生菌41株,检出率分别为485%和290%,耐药谱分析,酶型可能以CTXM为主。所有大肠埃希菌和肺炎克雷伯菌ESBL菌株都对亚胺培南敏感。6年监测结果相比,所测细菌对头孢哌酮/舒巴坦耐药率由1998～2000年的112%～167%增加至2001～2002年的295%～305%,以大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌较明显。大肠埃希菌对环丙沙星耐药率由1998～1999年的452%上升至2000～2002年的729%,?

Objective A surveillance study was performed in a hospital in Chongqing to investigate the change of antimicrobial resistance among nosocomial gram negative bacilli, especially those of Enterobacteriaceae isolated from intensive care units(ICU) from 1998 to 2003 Methods E test was used to determine the minimal inhibitory concentrations (MIC) of 547 isolates The situation of ESBLs producing strains was investigated among Escherichia coli and Klebsiella pneumoniae Results The most common pathogens were Escherichia coli, Pseudomonas aeruginosa , Klebsiella pneumoniae, Acinetobacter baumanni , and stenotrophomonas maltophilia , The most common pathogens in ICU were Escherichia coli , Pseudomonas aeruginosa , Klebsiella pneumoniae, Acinetobacter baumannii, enterobacter cloacae and stenotrophomonas maltophilia The antibiotic remaining the most active against all of the gram negative bacilli for 6 years was imipenem (with a susceptibility rate of 92 0% ) , followed by amikacin (81 5%) cefoperazone/sulbactam (79 3%) , ceftazidime (79 2%) , piperacillin/tazobactam (78 6%) ,and cefepime (74 4%) 50 ESBL producing strains among Escherichia coli and Klebsiella pneumoniae showed the highest susceptibility to imipenem and the lowest susceptibility to cefotaxime, 60 0% of which were susceptible to ceftazidime The bacterial resistance to cefoperazone/sulbactam has increased dramatically in recent years, especially in the isolates of E coli, K pneumoniae and A baumanii , while the average susceptibility rate of Escherichia coli to ciprofloxacin decreased from 54 8%(34/62) in 1998 1999 to 27 5%(30/109) in 2000 2003 Conclusion Imipenem remains hightly active against Enterbacteriaceae, but the activity of cefoperazone/sulbactam has decreased in recent years