2002—2003年中国革兰阴性细菌耐药性监测研究

2002-2003 Bacterial resistance surveillance study on Gram-negative bacilli in China

目的 监测我国不同地区 14家医院 31个研究病房的医院获得感染 (HAI)与社区获得感染 (CAI)患者中分离的革兰阴性细菌耐药状况。方法 按原设计方案对 14家医院从 2 0 0 2年 7月1日至 2 0 0 3年 6月 30日分离的 10 91株革兰阴性菌 ,采用国际标准平皿二倍稀释法进行体外敏感试验 ,测得MIC50 、MIC90 表示抗菌药物的抗菌活性 ,并按 2 0 0 2年美国临床实验标准委员会 (NCCLS)指导原则的标准计算细菌对抗菌药物的耐药率 (R) %、中介率 (I) %和敏感率 (S) %。结果 碳青霉烯类仍是对革兰阴性杆菌 (除外嗜麦芽窄食单胞菌与黄杆菌 ,该 2种非发酵阴性杆菌对碳青霉烯类高度耐药 )抗菌作用最强的一类抗生素。头孢哌酮 /舒巴坦、哌拉西林 /他唑巴坦、头孢吡肟和新氟喹诺酮类 ,如加替沙星、莫西沙星、左氧沙星对革兰阴性杆菌亦有很好的抗菌活性 ,但仍有 5 0 %～ 6 0 %的大肠埃希菌对氟喹诺酮类耐药。从HAI患者分离的革兰阴性杆菌耐药率比从CAI患者分离的相应阴性杆菌的耐药率要高 1 5倍以上。结论 头孢哌酮 /舒巴坦、哌拉西林 /他佐巴坦和加替沙星对非发酵阴性杆菌的抗菌谱较广 ,抗菌作用也较好 ,是值得注意的抗非发酵菌抗菌药物。我们从 2 0 0 2— 2 0 0 3年度所得的监测结果与 2 0 0 0— 2 0 0

Objective To determine the drug resistant pattern of Gram negative organisms isolated from patients with hospital acquired infection (HAI) or community acquired infection (CAI) in 31 study wards of 14 hospitals located at different areas in China Methods According to the previous protocol, from July 1 st 2002 to June 30 th 2003, a total of 1091 pathogenic strains of Gram negative organisms isolated from 14 hospitals were collected for in vitro susceptibility test using the international standard plate dilute method to assay the MIC 50 and MIC 90 as indicators representing the antibacterial activity of antimicrobial agents The resistant rate (R%), intermediate rate (I%) and susceptibility rate (S%) of drugs were calculated according to the criteria in guidelines of NCCLS (2002) Results Carbapenems were the most active antibiotics tested against Gram negative organisms (except Stenotrophomonas maltophilia and Flavobacteirium , the two non fermenters with high resistance to carbapenems) Cefoperazone/sulbactam, piperacillin/tazobactam, cefepim and new fluoroquinolones such as gentifloxacin, moxifloxacin and levofloxacin also showed excellent activity against Gram negative bacilli, however, there were 50% 60% of Escherichia coli still resistant to fluoroquinolones as we reported before Resistant rates of Gram negative bacilli from HAI patients were ≥1 5 times higher than those from CAI patients Conclusion Cefoperazone/sulbactam ,piperacillin tazobactam and getifloxacin were most interesting antimicrobial agents with broad spectrum as well as in vitro activity against non fermenters The results obtained in the surveillance year of 2002—2003 were comparable to the previous surveillance year of 2000—2001 as well as to the results reported from international surveillance program Some of difference in resistant rates among this report with those reported in the international journals were discussed