2008-2011年产气肠杆菌的临床分布及耐药性分析

Clinical distribution and drug resistance of Enterobacter aerogenes in 2008-2011

目的分析产气肠杆菌临床分布特点及对常用抗菌药物的耐药性变化,以更好地指导临床的合理使用抗菌药物。方法采用WHONET5软件统计分析2008年1月-2011年12月临床分离的产气肠杆菌临床分布和耐药率。结果 4年内共分离到产气肠杆菌459株,其中2008-2011年分别检出108、101、130、120株;病原菌主要来源于住院患者的痰液213株占46.4%、胆汁70株占15.3%、血液51株占11.1%、尿液50株占10.9%;4年耐药监测显示,亚胺培南和美罗培南的耐药率在2.0%～7.9%,呈明显的逐年上升趋势;头孢类抗菌药物除头孢唑林耐药率较高约90.0%外,其他如头孢替坦、头孢曲松、头孢他啶、头孢吡肟等耐药率由最高的55.5%下降至最低28.5%,氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦等复合制剂耐药率也由最高70.2%下降至最低21.1%,同时阿米卡星、庆大霉素等氨基糖苷类等药物的耐药率亦呈下降趋势,最高30.4%,最低为0,对喹诺酮类的耐药率约30.0%,保持相对稳定。结论 4年产气肠杆菌对头孢菌类、氨基糖苷类、复合制剂等药物的耐药率有所降低,而碳青霉烯类药物的耐药率呈上升趋势,说明细菌耐药性存在动态的变化,及时对细菌耐药性进行分析,依据药敏结果合理选用抗菌药物,严格掌握适应证,可减少或延缓耐药菌株的播散。

OBJECTIVE To study the characteristics of clinical distribution of Enterobacter aerogenes and the change of drug resistance to commonly used antibiotics so as to guide the reasonable clinical use of antibiotics. METHODS The clinical distribution and drug resistance of E. aerogenes isolated from 2008 to 2011 were statistically analyzed by WHONET5 software. RESULTS A total of 459 strains of E. aerogenes were isolated in the four years, including 108 strains in 2008, 101 strains in 2009, 130 strains in 2010, and 120 strains in 2011. Of all the pathogens isolated, there were 213 （46.4%） strains isolated from the sputum of the hospitalized patients, 70 （15.3%） strains from the bile, 51 （11.1%） strains from the blood, and 50 （10.9%） strains from the urine. The surveillance of the drug resistance in the four years indicated that the drug resistance rate to imipenem or meropen- em ranged between 2.0% and 7.9%, presenting a significantly upward trend and that except for 90.0% against cefazolin, the drug resistance rate to all the cephalosporins such as cefotetan, ceftriaxone, ceftazidime, and cefepime dropped from the highest of 55.5% to the lowest of 28.5% ; the drug resistance rate to ampicillin/sul- bactam, piperacillin/tazobactam, and cefoperazone/ sulbactam also decreased from the highest of 70.2% to the lowest of 21.1% ; the drug resistance rate to amikacin and gentamicin kept a downward trend, with 30.4 0% of the highest and 0% of the lowest; the drug resistance rate to quinolones was about 30.0%, which was relatively sta- ble. CONCLUSION The drug resistance rates of E. aerogenes isolated in the four years to cephalosporin, aminogly- coside, and compound antibiotics are decreased, however, the drug resistance rates to the carbapenem antibiotics keep an upward trend, revealing the dynamic change of the drug resistance. To analyze the bacterial resistance in a timely manner, reasonably use antibiotics on the basis of the drug susceptibility testing result, and strictly grasp the indications can curb the spread of the drug resistant strains.