2006-2007年度中国西北地区十家临床教学医院肠杆菌科细菌耐药性监测分析

Analysis of 2006-2007 Annual Drug Resistance Against Enterobacteriaceae in Northwest of China with Ten Clinical Teaching Hospitals

目的监测中国西北地区十家教学医院2006-2007年度临床分离的肠杆菌科菌群分布及其耐药性.方法常规方法培养分离医院内感染病原菌，并应用半自动或全自动细菌鉴定分析仪鉴定到种，药敏试验方法按CLSI规定的标准进行.监测数据按卫生部全国细菌耐药监测（Mohnarin）中心设计方案的要求定期上报.采用WHONET5．4软件进行数据统计分析.结果西北地区10家教学医院共分离出肠杆菌科细菌6422株，排名前五位的菌属分别为：埃希氏菌属2935株（45．70%）、克雷伯菌属1929株（30．04%）、肠杆菌属818株（12．74%）、变形杆菌属266株（4．14%）、枸橼酸杆菌属147株（2．29%）.对于ESBL的阳性率，大肠埃希菌（68．28%）高于肺炎克雷伯菌（45．14%）.所有肠杆菌科细菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率均〈30%;对阿米卡星、头孢吡肟的耐药率均〈40%;对其它三代头孢菌素不同程度耐药.大肠埃希菌对左氧氟沙星和环丙沙星的耐药率为63．00%-87．50%.结论碳青霉烯类、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星和头孢吡肟对肠杆菌科细菌均有较好的抗菌活性.大肠埃希菌、肺炎克雷伯菌ESBL酶的阳性率呈上升趋势，可能与临床长期广泛不舍理使用头孢菌素有关，应引起高度重视.大肠埃希菌对喹诺酮类药物的耐药性日趋增高，应慎重使用.针对肠杆菌科细菌的感染临床应根据细菌的耐药表型检测和药敏试验结果合理选用抗菌药物.

Objective Summarizing 2006-2007 annual distribution of microbial population and drug resistance against Enterobacteriaceae in northwest of China with ten clinical teaching hospitals. Methods Isolates were cultured by routine method and identified by the semi-automatic or automatic bacteria analysis system. Drug susceptibility test was according to CLSI standards. Supervising data delivered to MOH National Antimicrobial Resistant Investigation Net （Mohnarin） according to its plan. Data statistic and analysis used WHONET 5.4 software. Results In one years, 6 422 strains Enterobacteriaceae were isolated from ten teaching hospitals in northwest of China,the first to five bacteria ranged ：Escherichia 2 935 strains（45.70%） ,Klebsiella 1 929 strains（30. 04%）,Enterobacter 818 strains（12.74%）,Proteus 266 strains（4. 14%）,Citrobacter 147 strains （2.29 %）. The prevalence of extended-spectrum β-lactamases （ESBL） was 68. 28% in Escherichia coli, 45.14% in Klebsiella pneumoniae and 12.50% in Proteus mirabilis respectively. The drug resistant rates of all Enterobacteriaceae against imipenem, cefoperazone/sulbactam and piperacillin/tazobactam were less than 30%, less than 40% of amikacin and cefepime,the drug resistance of other third generation cephalosporins were varied. The drug resistant rate of E. coli against ciprofloxacin and levofloxacin was 63.00%-87. 50%. Conclusion Carbapenems,cefoperazone/sulbactam, piperacillin/tazobactam,amikacin and cefpirome are more susceptible to Enterobacteriaceae. The detection rates of ESBL- producing Escherichia coli and Klebsiella pneumoniae are ascending,which may be related to long-term widely arational use of the cephalosporins. The use of fluoroquinolones should be prudent for its resistance to E. coli is higher increasingly. Therefore,reasonable choice of antimicrobial agents should be based on the bacterial resistant drug phenotype detection and drug susceptibility test results against Enterobacteriaceae.