医院内肠杆菌科细菌耐药性监测结果分析

A surveillance on antimicrobial resistance of Enterobateriaceae isolated from the hospital from 1999 to 2003

目的:调查医院内肠杆菌科细菌常见临床分离株的耐药性。方法:采用K-B方法,对中国医科大学附属第一医院1999年1月￣2003年12月临床分离的肠杆菌科细菌进行药敏试验。根据NCCLS推荐方法检测大肠埃希菌和肺炎克雷伯菌产超广谱β内酰胺酶(ESBLs)的情况。结果:5年间,最常见的肠杆菌科细菌为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、变形杆菌属、沙雷菌属。耐药分析显示,亚胺培南一直对所有常见肠杆菌科细菌保持良好的抗菌活性,其次为头孢哌酮/舒巴坦和头孢吡肟,耐药率均<20%。氟喹诺酮类药物对除大肠埃希菌以外的其它肠杆菌细菌抗菌活性好。大肠埃希菌和肺炎克雷伯菌产ESBLs的比例逐年增高,分别从1999年的9.7%、18.4%上升到2003年的26.3%和33.9%(均P<0.05)。产ESBLs菌株对头孢噻肟和氨曲南的耐药率明显高于头孢他啶。结论:院内细菌耐药性监测不仅能指导临床合理使用抗菌药物,还能延缓耐药性的产生和蔓延。

Objectives:To investigate and compare the antimicrobial resistance of Enterobacteriaceae isolated from the First Affiliated Hospital of China Medical University.Methods:Antimicrobial susceptibility of clinical isolates from 1999 to 2003 were tested by Kirby-Bauer method.Extended spectrum beta-lactamases (ESBLs) of Escherichia coli and Klebsiella pneumoniae were detected by method recommended by NCCLS.Results:The most common Enterobacteriaceae were Escherichia coli,Klebsiella pneumoiae,Enterobacter cloacae,Proteus and Serratia.The analysis on antimicrobial resistance showed that imipenem was the most active compounds tested against Enterobacteroaceae,followed by cefoperazone/sulbactam and cefepime,which all the resistant rates were less than 20%.Ciprofloxacin and levofloxacin exhibited good antimicrobial activities except Escherichia coli.The incidence of ESBLs in Escherichia coli and Klebsiella pneumoniae gradually increased in the study period,which increased from 9.7% and 18.4% in 1999 to 26.3% and 33.9% in 2003 respectively.The resistant rates of ESBLs-producing strains to cefotaxime were higher than those to ceftazidime.Conclusion:Resistance surveillance not only helps to use antimicrobial agents rationally but also benefits to control the spread of resistant strains.