E-test监护病房革兰阴性杆菌耐药性的7年动态研究

Drug-resistance surveillance of Gram-negative bacilli isolated from ICU by E-test for a 7-year period

目的调查我院重症监护病房中革兰阴性杆菌耐药状况,了解超广谱β-内酰胺酶(ESBLs)菌株的产生率,并比较近年来我院细菌耐药性的变迁,为临床合理用药提供参考。方法用E-test法测定我院重症监护病房住院患者感染灶分离的108株革兰阴性杆菌对12种抗菌药物的最低抑菌浓度(MIC)及细菌产ESBLs的情况。结果亚胺培南对所有受试菌抗菌活性最高,耐药率为16.7%;头孢哌酮/舒巴坦、阿米卡星、头孢吡肟、哌拉西林/三唑巴坦及替卡西林/克拉维酸、头孢他啶和ertapenem的耐药率为34.2%～49%;其它4种抗菌药物耐药率均在60%～69.4%之间。筛选出大肠埃希菌、克雷伯菌属的ESBLs产生菌24株,ESBLs检出率分别为44.4%和53%;亚胺培南对所有大肠埃希菌和克雷伯菌属产ESBL株均较敏感。新型青霉烯类抗菌药物ertapenem(MK-0826)对收集的108株革兰阴性杆菌的抗菌活性较前下降,总耐药率为41.7%。七年资料相比,头孢哌酮/舒巴坦耐药率由16.7%增至37%,头孢他啶的耐药率亦明显增高,由1998年的26.2%增高到2005年的49%,除哌拉西林/三唑巴坦、替卡西林/克拉维酸的耐药率变化不大外,其他抗菌药物的耐药率变化较大。结论亚胺培南对所分离的细菌均表现较高的敏感性,对ESBLs产生菌亦有较强的抗菌活性。7年来细菌对所检测药物的耐药率均有不同程度增加。

Objective To investigate the resistant rates of Gram-negative bacilli in ICU and ESBLs- producting strains. Method Using E-test to detect the minimal inhibition concentration （MIC） of 12 antibi- otics against 108 strains of Gram-negative bacilli. Results The drug-resistance rate of imipenem is the lowest one, 16.7%; cefoperzone/sulbactam, amikacin, cefepime, piperacillin/tazobactam, ticarcillin/clavulanic acid ceftazidime and ertapenem have slightly higher drug-resistance rates of around 34.2%-49%, for others 60% -69. 4%. Twenty-four strains of ESBLs-producing bacilli have been selected from Escherichia coli and Klebsiella pneurnoniae, the positive rates are 44.4% and 53% respectively. Imipenem is susceptible to all Escherichia coli and Klebsiella pneumoniae. Compared to the survey in the last six years, the drug-resistant rate of cefoperzone/sulbactam is increased from 16.7% to 37%, ceftazidime increased from 26.2% in 1998 to 49% in 2005, other drugs have changed significantly except piperacillin/tazobactam and ticarcillin/clavulanic. Conclusion Imipenem remains the highest antibacterial activity against all the detected strains and is still effective to ESBLs-producing strains; in the last 7 years, due to the abuse of antibiotics with β-lactamase inhibitors leads to drug-resistant rate increase significantly.