儿科常见革兰阴性杆菌耐药性现状分析

Antibiotic resistance profile of common gram-negative bacterial pathogens isolated from children

目的了解不同地区儿童医院大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌总体耐药及流行情况。方法对2000—2006年5所医院送检标本中分离细菌进行耐药监测,K-B法检测药物敏感性及ESBLs。结果大肠埃希菌和肺炎克雷伯菌产ESBLs率较高,大肠埃希菌与头孢噻肟、头孢他啶及头孢吡肟耐药率成正相关,对第三代和第四代头孢菌素耐药率呈逐年上升趋势,该2种菌对亚胺培南最敏感。铜绿假单胞菌对各种药物耐药性呈波动趋势。上述细菌耐药性存在地区差异,北京和重庆地区耐药性偏高而上海地区耐药性较低。结论掌握各地耐药流行特点,严格用药适应证,应根据药敏试验结果合理选用抗菌药物。

Objective To investigate the prevalence and pattern of antibiotic resistance in Escherichia coli, Klebsiella pneumon- iae and Pseudomonas aeruginosa isolated from Chinese children and provide guidance for rational antimicrobial therapy. Methods Clinical isolates were collected from five Chinese pediatric hospitals during 2000 to 2006. Kirby-Bauer agar diffusion method was used to determine the antimicrobial susceptibility and extended spectrum beta lactamases （ESBLs） according to NCCLS cri- teria. Results The prevalence of ESBLs in E. coli and K. pneumoniae was relatively higher. Resistance rate of E. coli to cefotaxime, ceftazidime and cefepime showed increasing trend and was positively correlated to the prevalence of ESBLs. Imipenem was the most active antimicrobial agent against E. coli and K. pneumoniae. Drug resistance of P. aeruginosa was not high. The prevalence of antimicrobial resistance slightly fluctuated over time. Significant regional difference could be found for the three bacterial species in terms of resistance rate. The resistance was higher in Beijing and chongqing hospitals, but relatively lower in shanghai hospitals. Conclusions It is necessary to understand the prevalence and pattern of antibiotic resistance in each hospital in order to effectively control infection. Antimicrobial therapy should be based on the results of ongoing resistance surveillance.