霍乱弧菌耐药性连续六年监测研究

Consecutive 6-year Surveillance of Antimicrobial Resistance of Vibrio Cholera

目的探讨广州地区霍乱弧菌的耐药变迁,以指导临床合理使用抗生素。方法1998～2004年从广州地区病人、外环境水和水产品中分离到的267株霍乱弧菌,采用WHO推荐的琼脂扩散法(改良K-B法)测定氧氟沙星等22种抗生素对这些菌株的敏感性。结果6年中,对霍乱弧菌活性最高,且历年其活性不减的是氧氟沙星、阿米卡星、头孢呋辛和头孢曲松(敏感率均为100%),其次是环丙沙星、诺氟沙星、庆大霉素、妥布霉素、新霉素、卡那霉素、优立新(氨苄西林/舒巴坦)、头孢他定、头孢哌酮、头孢拉定和强力霉素,它们的敏感率在90.6%～99.6%之间。氨苄西林、头孢氨苄、复方新诺明的敏感率分别为89.5%、86.1%、85.0%;氯霉素的敏感率为79.0%;其它抗生素的敏感率不足52.0%。埃尔托型霍乱弧菌对氨苄西林、复方新诺明的敏感率高达95.6%、89.4%,而O139群霍乱弧菌敏感率仅为56.1%、61.0%(经χ2检验,P<0.005),对痢特灵的敏感性埃尔托型霍乱弧菌(38.3%)明显低于O139群霍乱弧菌(83.3%),两者有显著性差异(χ2=27.97,P<0.005)。结论氧氟沙星、阿米卡星、头孢呋辛、头孢曲松对霍乱弧菌保持非常高的敏感性,这些药物是霍乱防治的首选药物。

Objective To investigate the trends of antimicrobial resistance of Vibrio cholera in order to guide the clinical administration of antibiotics rationally. Methods K-B test was employed to determine the susceptibility of 267 strains of Vibrio cholera isolated from patients, water and seafood in Guangzhou area from 1998 to 2004. Results The antibiotics that remained the most active against Vibrio cholera in this consecutive 6-year period were floxin, amikacin, cefuroxime and ceftriaxone(with a susceptibility rate of 100%), followed by ciprofloxacin, norfloxacin, gentamicin, tobramycin, neomycin, kanamycin, ampicillin/sulbacfan, ceftazidime, cefoperazone, cephradine and doxyeycline(with a susceptibility rate between 90.6% and 99.6%).The susceptibility rate of Eltor Vibrio cholera to ampicillin and sulfarmethoxazole/trimethoprim was 95.6% and 89.4% respectively; while that of O139 serogroup Vibrio cholera was only 56.1%(P<0.005). And the statistical susceptibility rate of Eltor Vibrio cholera to furazolidone ( 38.3% ) was significantly lower than that of O139 Vibrio cholera (83.3%)(χ 2=27.97,P<0.005). Conclusion Floxin, amikacin, cefuroxime and ceftriaxone remain highly active against Vibrio cholera, they are the medication of priority for cholera treatment and prevention.