亚胺培南对革兰阴性杆菌的耐药性变迁

Change of drug resistance of gram-negative bacilli to imipenem

目的调查2007-2011年亚胺培南对革兰阴性杆菌耐药性变化,为亚胺培南的临床应用提供依据。方法利用医院的WHONET数据,回顾性分析亚胺培南对2007-2011年临床分离的3801株革兰阴性杆菌的耐药性。结果 2007-2011年革兰阴性杆菌,耐药率在15.2%～19.6%,平均16.9%,5年间差异无统计学意义;肠杆菌科细菌耐药率在1.6%～7.9%,平均3.7%,5年间差异有统计学意义(P<0.05),2007-2010年呈递增趋势,2011年下降至2.3%;产超广谱β-内酰胺酶阳性(ESBLs)大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌、奇异变形菌耐药率在0～8.5%,平均3.3%,5年间差异有统计学意义(P<0.05),2007-2010年呈递增趋势,2011年下降;非产ESBLs大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌、奇异变形菌,5年间无耐亚胺培南株;非发酵菌在34.9%～41.5%,平均37.5%,5年间差异有统计学意义(P<0.05),2007-2010年呈递增趋势,2011年下降;铜绿假单菌在43.0%～9.1%,平均28.0%,5年间差异有统计学意义(P<0.05),呈递减趋势;鲍氏不动杆菌在3.3%～49.0%,平均34.3%,5年间差异有统计学意义(P<0.05),呈递增趋势。结论亚胺培南对于革兰阴性杆菌仍有较高的敏感性;其中,对肠杆菌科细菌的抗菌活性极强,对非发酵菌稍差,对铜绿假单胞的抗菌活性优于鲍氏不动杆菌。

OBJECTIVE To investigate the change of drug resistance of the gram-negative bacilli to imipenem so as to provide basis for the clinical use of imipenem.METHODS The WHONET data of the hospital was employed to retrospectively analyze the drug resistance of 3801 strains of gram-negative bacilli isolated from 2007 to 2011.RESULTS The drug resistance rates of the gram-negative bacilli isolated from 2007 to 2011 varied between 15.2% and 19.6% with the average of 16.9%,the difference was statistically significant during the five years.The drug resistance rate of the Enterobacteriaceae strains varied between 1.6% and 7.9% with an average of 3.7%,and the difference was statistically significant during the five years（P0.05）,the drug resistance rate kept an upward trend in 2007-2010,descending down to 2.3%.The drug resistance rates of the extended spectrum beta lactamase（ESBL）-producing Escherichia coli,Klebsiella pneumoniae,Klebsiella oxytoca,and Proteus mirabilis varied between 0% and 8.5% with an average of 3.3%,the difference was statistically significant during the 5 years（P 0.05）,the drug resistance rate kept an increasing trend in 2007-2010 and dropped in 2011.Of all the non-ESBL-producing E.coli,K.pneumoniae,K.oxytoca,and P.mirabilis strains,there were no imipenem-resistant strains in the five years.The drug resistance rate of the non-fermenting bacteria varied between 34.9% and 41.5% with an average of 37.5%,the difference was statistically significant（P 0.05）,the drug resistance rate showed an increasing trend in 2007-2010 and then dropped 2011.The drug resistance rate of the Pseudomonas aeruginosa strains varied between 43.0% and 9.1% with an average of 28.0%,the difference was statistically significant in the 5 years（P 0.05）,the drug resistance rate kept an downward trend.The drug resistance rate of the Acinetobacter baumannii strains varied between 3.3% and 49.0% with an average of 34.3%,the difference was statistically significant（P0.05）,the drug resistance rate showed an upward trend. CONCLUSION The gram-negative bacilli remain highly sensitive to imipenem,among which the Enterobacteriaceae strains have strong antibacterial activity,the non-fermenting bacteria do not have strong antibacterial activity,and the P.aeruginosa strains have stronger antibacterial activity than did the A.baumannii strains.