台州地区临床分离的革兰阴性菌对亚胺培南耐药率的变迁

Vicissitudes of Resistance to Imipenem in Gram-negative Bacilli

目的调查近年来革兰阴性杆菌对亚胺培南的耐药率变化。方法收集2004年1月-2008年1月从医院住院患者各种临床标本中分离的革兰阴性杆菌,使用VITEK-AMS全自动微生物分析仪进行菌种的鉴定和药敏试验,对结果进行回顾性调查。结果共分离出革兰阴性杆菌6983株,92个细菌种,肠杆菌科细菌2986株,占42.8%;非发酵菌3961株,占56.7%;分离率前5位的细菌分别是大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌和洋葱伯克霍尔德菌;肠杆菌科细菌对亚胺培南的耐药率<1.0%;嗜麦芽寡养单胞菌、洋葱伯克霍尔德菌、脑膜脓毒金黄杆菌、铜绿假单胞菌和鲍氏不动杆菌对亚胺培南的耐药率分别为98.4%、97.0%、98.2%、70.1%和47.5%。结论临床分离的革兰阴性杆菌以非发酵菌为主,亚胺培南对肠杆菌科细菌具有非常强的体外抗菌活性,对非发酵菌的体外抗菌活性较差,铜绿假单胞菌和鲍氏不动杆菌对亚胺培南的耐药率呈上升趋势。

OBJECTIVE To investigate the vicissitudes of resistance to imipenem in Gram-negative bacilli isolated from clinical specimens. METHODS Gram-negative bacilli were isolated from various clinical specimens in our hosptial from Jan 2004 to Jan 2008. The identification and antimicrobiol susceptiblity test was determined by VITEK-AMS full automated microbiology analyzer. RESULTS A total of 6983 strains of Gram-negative bacilli were isolated,including 92 species and 2986 isolates of Enterobacteriaceae and 3961 isolates of non-fermenters, accounted for 42.8% and 56.7%, respectively. The resistant rate of Enterobacteriaceae to imipenem was lower than 1.0%. The resistant rates of Stenotrophornonas maltophilia , Burkholderia cepacia , Chryseobacteriurn meningosepticum, Pseudornonas aeruginosaand Acinetobacter baurnannii to imipenem were 98. 4%, 97. 0%, 98.2 %, 70.1% and 47.5 %, respectively. CONCLUSIONS Non-fermenters are predominant pathogens. Imipenem has high antimicrobial activity to Enterobacteriaceae in invro, but not to non-fermenters. The resistant rates of P. aeruginosa and A. baumannii to imipenem are increasing gradually.