2004—2005年中国CHINET鲍曼不动杆菌耐药性分析

CHINET surveillance of antimicrobial resistance among A. baumannii isolates in China during 2004—2005

目的监测2004-2005年中国不同地区7所教学医院临床分离鲍曼不动杆菌的耐药性。方法收集从患者分离的非重复鲍曼不动杆菌1787株,在各监测点采用纸片扩散法测定菌株对头孢哌酮-舒巴坦等13种抗菌药物的敏感性,数据采用WHONET5.3软件分析。结果鲍曼不动杆菌对亚胺培南和美罗培南敏感率最高,分别为65.1%和56.8%。其次为头孢哌酮-舒巴坦和氨苄西林-舒巴坦,敏感率分别为43.5%和39.2%。其他抗菌药物的敏感率均在2.2%～34%。2种碳青霉烯类药物和2种含舒巴坦制剂的敏感性具有明显的一致性。特定药物在不同地区的敏感率有较大差异。对亚胺培南不敏感的菌株除对头孢哌酮-舒巴坦和氨苄西林-舒巴坦耐药率分别为52.1%和76.8%外,对其他药物耐药率均在80%以上。而对亚胺培南敏感的菌株,除对美罗培南、头孢哌酮-舒巴坦、氨苄西林-舒巴坦耐药率分别仅为11%、12.5%和29.1%,对其他抗菌药物的耐药率均在40%以上。结论碳青霉烯类抗生素仍是对鲍曼不动杆菌抗菌活性最高的药物,但对碳青霉烯类耐药的鲍曼不动杆菌(CRAB)已达43.1%,并在部分地区造成医院内流行。头孢哌酮-舒巴坦对鲍曼不动杆菌抗菌活性仅次于碳青霉烯类,且中介率较高,尤其对CRAB是敏感率最高的药物。

Objective To investigate the antimicrobial resistance among Acinetobacterbaumannii isolated from 7 teaching hospitals at different cities in China from 2004 to 2005. Methods A total of 1 787 nonduplicate A. baumannii isolates were collected. The antimicrobial susceptibility was determined by disk diffusion method in every center. All the data were analyzed by WHONET 5.3 software. Results Imipenem （65.1 % susceptible） and meropenem （56.8% susceptible） were the most active agents against A. baumannii, followed by cefoperazone-sulbactam （43.5% susceptible, 30.1 % intermediate） and ampicillin-sulbactam （39. 2% susceptible, 16. 3% intermediate）. The susceptibility rate of A. baumannii to other antimicrobial agents ranged from 2.2% to 34%. Antimicrobial susceptibility pattern varied in different cities. About 52.1% and 76.8% of the imipenem non-susceptible strains were also resistant to cefoperazone-sulbactam or ampicillin-sulbactam, respectively. More than 81 % were resistant to any of the other antimicrobial agents. Imipenem-susceptible strains also showed lower resistance to meropenem （11% ）, cefoperazone-sulbactam （ 12.5 % ） and ampicilliwsulbactam （29. 1 % ）, but higher resistance to other antimicrobial agents （41.6%-58. 40%）. Conclusions Carbapenems are still the most active agent against A. baumannii. However, nearly 43.1% of A. baumannii strains are resistant to carbapenems. Such resistant strains are prevalent in some regions. Cefoperazone-sulbactam is the second most active agent against A. baumannii only next to carbapenems, especially for carbapenem-resistant A . baumannii （CRAB）.