耐三代头孢菌素的肠道病原菌的增长趋势和耐药谱

Increasing tendency and resistant spectrum of enteric pathogens of resistant to third-generation cephalosporins

目的监测我院2001—2010年与腹泻有关的耐三代头孢菌素肠道病原菌的增长趋势和耐药谱。为本地区的流行病学研究及临床合理用药提供依据。方法通过大便标本培养，致病菌经生化及血清学进一步鉴定到种或群．并以纸片扩散法测定抗菌药物的敏感性。采用WHONET5．3软件对药敏结果进行统计和分析。结果10年分离出219株耐三代头孢菌素的腹泻病原菌，占同期整个肠道致病菌的9．91％，包括沙门菌9株（4．11％）、志贺菌120株（54．79％）、气单胞菌20株（9．13％）、类志贺毗邻单胞菌2株（0．91％）、致泻大肠埃希菌40株（18．26％）及弧菌28株（12．79％），检出率由2001年的1．5％上升至2010年的近30．0％。219株耐三代头孢菌素病原菌对广谱青霉素和复方新诺明的耐药率均在85．0％以上．对头孢吡肟、头孢美唑、氟喹诺酮类、氯霉素的耐药率在20．0％～36．5％，对磷霉素的耐药率最低（6．7％）。福氏志贺菌、致泻大肠埃希菌、气单胞菌和弧菌对氟喹诺酮类的耐药率明显高于宋内志贺菌；气单胞菌和弧菌对头孢美唑的耐药率高于福氏志贺菌、致泻大肠埃希菌和宋内志贺菌；气单胞菌对磷霉素的耐药率显著高于其他致病菌。结论耐三代头孢菌素的肠道病原菌上升迅速，耐药广泛，不同种属的耐药性不同，应重视监测，加强防治。

Objective To monitor the increasing tendency and resistant spectrum of enteric pathogens of resistant to third-generation cephalosporins from 2001 to 2010 for offering the date to guide epidemiologic study and clinical treatment. Methods The bacteria induced diarrhea was cultured and identified to species or group with the biochemical and serologic test. Then, the susceptibility of bacteria to antimicrobial agents was tested by K-B method. The result of drug sensitive test was analyzed by WHONET 5.3. Results There were total 219 strains resistant to third-generation cephalosporins were isolated in 10 years, including Salmonella 9 strains（4.11%）, Shigella 120 strains （54.79%）, Aeromonos 20 strains（9.13%）, Plesiomonas shigelloides 2 strains （0.91%）, Escherichia coli 40 strains （18.26%） induced diarrhea and Vibrio 28 strains （12.79%）, accounting 9.91% in enteric pathogens. These strains increased form 1.5% in 2001 to nearly 30.0% in 2010. The resistant rate of enteric pathogens of resistant to third-generation cephalosporins to extended spectrum penicillin and eotrimoxazole were all above 85.0%. The resistant rate to cefepime, eefmetazole, flnoroquinolones and chloram- phenicol were between 20.0%~36.5%. The lowest resistant rate to fosfomycin was 6.7%. The resistant rates of Shigellaflexneri, cause diarrhea Escherichia coli, A eromonas and Vibrio to fluoroquinolones were higher than Shigella sonnei. The resistant rates of A eromonas and Vibrio to eefmetazole were higher than ShigeUaflexneri, cause diarrhea Escherichia coli and Shigella sonnei. And the resistant rate of Aeromonas to fosfomycin was higher than other pathogens. Conclusion It is necessary to supervise the prevention and treatment because the resistant rate and spectrum of enteric pathogens to antibiotics is increasing quickly.