2003-2007年重症监护病房革兰阴性杆菌的变迁与耐药性监测

Surveillance of Antimicrobial Resistance among Gram-negative Bacilli from Intensive Care Unit

目的调查近5年重症监护病房(ICU)革兰阴性杆菌分离率及对常用抗菌药物的耐药性变化趋势,以指导临床合理使用抗菌药物。方法分析2003年1月-2007年12月ICU分离出的革兰阴性杆菌,采用纸片扩散法进行药敏检测,并用WHONET5.3软件进行数据分析。结果650株革兰阴性杆菌中占前3位的为不动杆菌属39.1%、铜绿假单胞菌20.9%及大肠埃希菌14.7%;不动杆菌属对亚胺培南、头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率最低,分别为3.7%、28.3%和42.9%;近2年铜绿假单胞菌对亚胺培南的耐药率明显升高(58.0%);除嗜麦芽寡养单胞菌外,亚胺培南对其他革兰阴性杆菌保持强大的抗菌活性,嗜麦芽寡养单胞菌对头孢他啶的耐药率仍最低19.4%;革兰阴性杆菌对头孢哌酮/舒巴坦与哌拉西林/他唑巴坦的耐药率<50.0%,对其他抗菌药物高度耐药,5年中耐药率无明显变化。结论非发酵菌在ICU革兰阴性杆菌中占有较高比例,亚胺培南(除嗜麦芽寡养单胞菌外)、头孢哌酮/舒巴坦与哌拉西林/他唑巴坦对革兰阴性杆菌具有很好的敏感性,对其他抗菌药物耐药率较高。

OBJECTIVE To study the bacterial resistance variation rates among Gram-negative bacilli from our hospital＇s intensive care unit （ICU） during recent five years, as a guidance for rational use of antibiotics. METHODS From Jan 2003 to Dec 2007, antimierobial susceptibility testing was performed on the Gram-negative bacilli isolated from ICU in our hospital by Kirby-Bauer method. The results were analyzed by WHONET 5.3. RESULTS The first three pathogens of 560 strains were Acinetobacter spp （39. 1 %）, Pseudomonas aeruginosa （20.9%） and Escherichia coli （14. 7%）. The resistance rate of Acinetobacter spp to imipenem, cefoperazonesulbactam and piperacillin-tazobactam were 3.7%, 28. 3% and 42. 9%, respectively. The resistance rate of P. aeruginosa to imipenem were increasing in recent 2 years （58 %）, the susceptibility rate of Gram-negative bacilli to imipenem was the higest （except Stenotrophomonas maltophilia）. The resistance rate of S. maltophilia to ceftazidime was the lowest （19.4%）. The resistance rate of Gram-negative bacilli to cefoperazone-sulbactam and piperaeillin-tazobactam was lower （〈50.0%）, but to other antibiotics was much higer. CONCLUSIONS In ICU, the most Gram-negative bacilli are non-fermentative, imipenem（except S. maltophilia）, cefoperazone-sulbactam and piperacillin-tazobactam remain highly active against Gram-negative bacilli, the activities of other antibiotics are lower.