我院外科肠杆菌科细菌感染分布及耐药性变迁

Distribution and changes of drug resistance of Enterobacteriaceae bacteria in surgical system in our hosipital

目的观察和监测我院外科系统分离的肠杆菌科细菌对常用抗菌药物的耐药变化。方法连续监测2005年～2011年本院外科系统常见肠杆菌科细菌的耐药状况。用纸片扩散法(Kirby-Bauer)检测临床分离菌对各种常用抗菌药物的耐药性,参照2010版CLSI标准判定药敏结果,并用WHONET5.5软件统计分析。结果 7年外科系统共检出肠杆菌科细菌1366株,分离前五位的细菌分别是大肠埃希菌(53.2%)、肺炎克雷伯菌(20.2%)、阴沟肠杆菌(7.6%)、奇异变形菌(6.2%)和摩根摩根菌(2.4%)。2005—2010年未发现耐碳青酶烯类抗菌药肠杆菌科细菌,但2011年亚胺培南和美罗培南耐药率分别是0.3%和0.3%,哌拉西林/三唑巴坦和阿米卡星有较好的抗菌活性,耐药率分别为2.7%～7.2%和6.5%～12.2%。环丙沙星和左氧氟沙星总耐药率接近50%。7年间大肠埃希菌对各类抗菌药物的耐药率变化不大,肺炎克雷伯菌对阿米卡星的耐药率变化较明显,低至2005年的7.1%,高至2007年的36%,2008—2011年,其耐药率又逐年下降,为21%～7.2%。大肠埃希菌和肺炎克雷伯菌产ESBLs菌株的总检出率分别为50.0%和37.5%,产ESBL株耐药率明显高于非产ESBL株(P<0.05)。结论亚胺培南对肠杆菌科细菌仍有较好的抗菌活性,2011年发现的对碳青霉烯类药物耐药的肠杆菌科细菌菌应引起关注。

Objective To investigate the distribution and changes of antibiotic resistance of Enterobacteriaceae bacteria in Surgical system collected from Donghua Hospital from 2005 to 2011. Methods Kirby-Bauer method was used to test the susceptibility of clinical isolates to selected antimicrobial agents. The results were analyzed according to the 2010 CLSI sandard. The susceptibility datas were analyzed using WHONET5.4 software. Results A total of 1366 Enterobacteriaceae bacterias from variors clinical speciments in Surgical system for 7 yeas. The first to five bacteria ranged： Escherichia coli （53.2%）, Klebsiella pneumonia （20.2%）, Enterobacter cloacae （7.6%）, Proteus mirabilis （6.2%） and Morgan Morgan bacteria （2.4%）. No carbapenem -resistant Enterobacteriaceae bacteria was found from 2005 to 2010. However, imipenem and meropennem resistance rate were 0.3% and 0.3% respectively in 2011. Piperacillin/tazobactam and amikacin have good antibacterial activity, resistance rates were 2.7%-7.2% and 6.5% to 12.2% respectively. Ciprofloxacin and levofloxacin resistance rates were nearly 50%. Various antimicrobial agents against Escherichia coli resistance rates changed little. Klebsiella pneumoniae resistance rates for amikacin more obvious changes, as low as 7.1% in 2005, up to 36% in 2007, the resistance rate has decreased year by year, 21% to 7.2% in 2008 to 2011 years. ESBLs-producing strains accounted for 50.0% in E. coli and 37.5% in K. pneumoniae. The resistant rates of antibiotics against the ESBL positive strains are higher than ESBL negative strains. Conclusion Imipenem and meropennem remain highly against activity against Enterobacteriaceae but carbapenems-resistant Enterobacteriaceae were found in 2011. It should be cause for concern.