2005-2012年肠杆菌科细菌分布及耐药性变迁

Distribution and changes of drug resistance of Enterobacteriaceae bacteria from 2005 to 2012

目的观察和监测临床分离的肠杆菌科细菌对抗菌药物耐药变化，为指导临床用药提供依据。方法连续监测2005—2012年肠杆菌科细菌的耐药性，用纸片扩散法检测临床分离菌对抗菌药物的耐药率，参照2012版CLSI标准判断结果，并用WHONET5．5统计分析。结果8年来共检出肠杆菌科细菌5323株，分离前5位的病原菌分别是大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、奇异变形菌和产气肠杆菌，分别占51．0％、26．3％、6．6％、4．4％、2．8％；敏感性最高的抗菌药物为碳青霉烯类药物，阿米卡星和哌拉西林／他唑巴坦对肠杆菌科细菌亦保持较好的抗菌活性，耐药率为2．4％～10．1％。结论肠杆菌科细菌对各类抗菌药物呈现不同程度耐药，并具多药耐药特点；头孢菌素类抗菌药物耐药率呈现逐年增高趋势；碳青霉烯类仍是肠杆菌科细菌最敏感的药物，但已出现碳青霉烯耐药菌，应引起重视。

OBJECTIVE To observe and monitor the distribution and changes of drug resistance of clinically isolated Enterobacteriaceae bacteria and provide the basis for the guidance of clinical rational medication. METHODS The drug resistance of Enterobacteriaceae bacteria from 2005 to 2012 were continuously monitored, and K-B method was used to test the drug resistance of clinical isolates to the antimicrobial drugs. Results were analyzed according to the CLSI standard, Rev. 2012, and the statistical analysis was performed using WHONET 5. 5 software. RESULTS A total of 5, 323 Enterobacteriaceae bacteria were dectected in our hospital for 8 years. The top five bacteria were Escherichia coli （51.0 % ）, Klebsiella pneumonia （2 6.3 % ）, Enterobacter cloacae （6.6 % ）, Proteus mirabilis （4.4 %） and Enterobacter aerogenes （2. 8%）. Enterobacteriaceae bacteria was mostly sensitive to the drugs such as carbapenem. Amikacin and piperacillin/tazobactam were of equally activity against Enterobacteriace- ae bacteria, and the drug resistance rates were 2.4% % -10.1 %. CONCLUSION Enterobacteriaceae bacteria have different degrees of drug resistance to various antimicrobial drugs, with the characteristics of multi-drug resist-ance. The drug resistance rate to cephalosporin showed a trend of increase with years. Carbapenems remained to be the most sensitive drugs of Enterobacteriaceae, but the carbapenem resistant strains have appeared and more attention should be paid to the issue.