1990—2004年上海地区临床分离大肠埃希菌耐药性变迁

Changes of antimicrobial resistance among clinical isolates of Escherechia coil in Shanghai 1990-2004

目的了解临床分离大肠埃希菌对抗菌药耐药性变迁情况。方法对1990至2004年上海地区11所医院的细菌耐药监测资料中大肠埃希菌临床分离株的耐药性变迁情况进行分析,细菌药敏采用K irby-Bauer法。结果临床分离大肠埃希菌33 495株对21种抗菌药药敏试验结果显示,该菌对大多常用抗菌药的耐药性在15年间呈上升趋势。对氨苄西林、哌拉西林的耐药率自69.0%和30.0%分别增至85.0%和71.4%。对头孢菌素类中的头孢唑啉(24.0%→48.3%)、头孢呋辛(18.0%→45.7%)、头孢克洛(33.3%→46.8%)的耐药率均增长,尤其是头孢噻肟的耐药率自1990年的6.0%增至2004年的35.2%。对氟喹诺酮类的耐药性15年间明显增高,且各品种间呈交叉耐药,自1990年的11.0%增至2004年的55.4%。对庆大霉素的耐药率缓慢上升(44.0%→54.0%)。大肠埃希菌对四环素、氯霉素、磺胺甲唑/甲氧苄啶(SMZ/TMP)耐药率始终较高。头孢他啶、头孢吡肟、亚胺培南、阿米卡星、β内酰胺类/β内酰胺酶抑制剂复方、呋喃妥因则保持了对大肠埃希菌的良好抗菌活性。产超广谱β内酰胺酶(ESBL)大肠埃希菌所占比例在2000—2004年间逐渐上升,自14.7%增至36.5%,产ESBL菌株耐药性均明显高于非产ESBL者。结论临床分离的大肠埃希菌对常用抗菌药的耐药性在1990—2004年的15年间普遍呈明显增高趋势。

Objective To investigate the trend of resistance to antimicrobial agents among clinical isolates of Escherichia coli 1990-2004. Methods Agar diffusion test was used to analyze the changes of drug susceptibility of 33 495 strains of E. coli isolated from 11 hospitals in Shanghai to 21 antimicrobial agents 1990-2004. Results The resistance rates of 33 495 E. coli isolates to 21 antimicrobial agents mostly increased 1990-2004. The resistance rates to ampicillin and piperacillin increased from 69% and 30% to 85% and 71.4% respectively. The resistance rates to cephalosporins, except cefiazidime and cefepime, all increased, e. g. , the resistance rates to cefazolin （24.0%±8. 3% ） ,cefuroxime （ 18.0%±5.7% ） ,and cefaclor （33.3%±46. 8% ）, especially that to cefotaxime （6. 0%±35.2% ）. The resistance rate to fluoroquinolones increased from 11.0% to 55.4%. The resistance rate to gentamicin increased from 44. 0% to 54. 0%. The resistance rates to tetracycline, chloramphenicol, SMZ/TMP remained at high levels. However, ceftazidime, cefepime, imipenem, amikacin, β-lactams/β-1actamase inhibitors, and nitrofurantoin remained active against the E. coli isolates. The detectable rate of extended-spectrum β-1actamase-producing strains in E. coli increased from 14. 7% to 36.5%. Conclusion The trend of resistance of E. coli to commonly used antimicrobials was upward 1990-2004.