呼吸监护病区患者下呼吸道分离革兰阴性杆菌连续5年耐药性监测

Surveillance of antimicrobial resistance in gram-negative bacilli isolated from lower respiratory tract of patients in Respiratory Intensive Care Unit for 5 consecutive years

目的探讨本所呼吸监护病区(RICU)患者下呼吸道分离革兰阴性杆菌的耐药变迁,指导临床合理使用抗菌药。方法2000-2004年从RICU患者下呼吸道分离的非重复的1047株革兰阴性杆菌采用Kirby-Bauer法进行药敏试验,数据分析采用WHONET5.3软件。结果最常见的病原菌为铜绿假单胞菌(42.9%)、嗜麦芽窄食单胞菌(17.1%)、鲍曼不动杆菌(10.0%)和肺炎克雷伯菌(6.5%)。敏感率较高的抗菌药是头孢他啶(50%～74%)、阿米卡星(33.3%～81.0%)、哌拉西林-三唑巴坦(30.4%～64.6%)、头孢哌酮-舒巴坦(33.5%-47.5%),亚胺培南的敏感率波动性较大。对嗜麦芽窄食单胞菌敏感性较高的药物是头孢哌酮-舒巴坦(47.2%～78.6%)和替卡西林-克拉维酸(28.3%～86.6%)。鲍曼不动杆菌对亚胺培南的敏感率始终保持在90%以上,头孢哌酮-舒巴坦的敏感率(18.2%～68.2%)与阿米卡星(31.8%～76.2%)相近。肺炎克雷伯菌对亚胺培南和头孢吡肟的敏感率最高,分别为92.9%～100%和55.6%～80.0%,哌拉西林-三唑巴坦的敏感率由58.3%降至21.7%。肺炎克雷伯菌产ESBLs株检出率由2002年的11.1%上升至2004年的47.8%。结论5年来本研究监测的细菌耐药率明显升高,加强耐药性监测,合理使用抗菌药物非常重要。

Objective To investigate the changing pattern of antimicrobial resistance among gram-negative bacilli isolated from respiratory intensive care unit （RICU） for rational use of antimicrobial agents. Methods Antimicrobial susceptibility of 1 047 isolates of gram-negative bacilli from 2000 to 2004 was tested by disk diffusion method. WHONET 5. 3 software was used to analyze the data. Results The most common pathogens were Pseudomonas aeruginosa （42. 9%）, Stenotrophomonas maltophilia （17.1% ）, Acinetobacter baumannii （10.0%） and Klebsiella pneumoniae （6.5 % ）. The susceptibility rate of P. aeruginosa was relatively higher to ceftazidime （50 %-74 % ）, amikacin （33.3 %-81.0 % ）, piperacillin-tazobactam （30.4 %-64.6 % ） and cefoperazone-sulbactam （33.5 %/00-47. 5%）, while the susceptibility to imipenem decreased. The susceptibility rate of S. maltophilia was relatively higher to cefoperazone-sulbactam （47.2 %/00-78.6 % ） and ticarcillin-clavulanic acid （28.3 %-86.6 % ）. More than 90% of Acinetobacter baumannii isolates were susceptible to imipenem. The susceptibility rates of K. pneumoniae to imipenem and cefepime were 92.9%-100% and 55.6%-80.0%, respectively. The susceptibility rate to piperacillin-tazobactam decreased from 58.3% to 21.7%. The prevalence of extended-spectrum β-1actamases （ESBLs） in K. pneumoniae increased from 11.1% in 2002 to 47.8% in 2004. Conclusions Most pathogens show significant resistance to the most commonly used antibiotics. It is very important to select antibiotics for the treatment of infections in ICU based on the results of susceptibility.