2000-2011年大肠埃希菌对抗菌药物耐药性荟萃分析

Meta-analysis of drug resistance of Escherichia coli to antibiotics from 2000 to 2011

目的分析中国内地2000-2011年大肠埃希菌对头孢菌素和喹诺酮类药物的耐药性,探讨细菌耐药性发展趋势及其防治措施。方法搜集2000-2013年中国内地期刊报道的大肠埃希菌对头孢呋辛、头孢曲松、左氧氟沙星、环丙沙星耐药数据,应用荟萃分析法,使用EXCEL软件进行数据合并汇总与统计分析。结果大肠埃希菌对4种抗菌药物耐药性呈年度上升趋势,2008年前增长较快,2008年后维持高耐药性;2008年前对喹诺酮类左氧氟沙星、环丙沙星耐药率高于头孢菌素类头孢曲松和头孢呋辛(P<0.05),2008年后两者接近;对头孢呋辛的耐药率高于头孢曲松(P<0.05),对环丙沙星和左氧氟沙星的耐药率差异无统计学意义;大肠埃希菌产超广谱β-内酰胺酶(ESBLs)检出率呈逐年上升趋势(P<0.01),产ESBLs大肠埃希菌耐药率高于非产ESBLs大肠埃希菌耐药率(P<0.01);中国内地以华东地区分离的大肠埃希菌对4种抗菌药物总耐药率最低,其他各地区分离的大肠埃希菌耐药率差异无统计学意义。结论大肠埃希菌对头孢呋辛、头孢曲松、左氧氟沙星、环丙沙星的耐药率逐年升高;加强抗菌药物的管理和规范使用,高度重视医院感染的防治和产ESBLs大肠埃希菌的连续监测,有助于控制大肠埃希菌耐药性的形成与扩散。

OBJECTIVE To analyze the drug resistance of Escherichia coli（E, coli） to cephalosporins and quinolones in Chinese mainland from 2000 to 2011 and to explore the development tendency of bacterial drug resistance and the relevant control measures. METHODS The drug resistance data of E. coli to cefuroxime, ceftriaxone, levoflox- acin and ciprofloxacin reported by Chinese journals from 2000 to 2013 were collected, and were summarized and statistically analyzed with Excel software through meta analysis method. RESULTS The drug resistance of E. coli to 4 types of antibiotics presented an annually upward trend; it increased fast before 2008 and kept high after 2008~ the drug resistance rates of E. coli to levofloxacin and ciprofloxacin were higher than that to ceftriaxone （P 〈0.01） and cefuroxime （P〈0.05） before 2008, and got closer after 2008; its resistance to cefuroxime was higher than that to ceftriaxone （P〈0.05）, and there was no significant difference between the drug resistance rates to ciprofloxacin and levofloxacin~ the detection rate of extended spectrum ~3-Laetamases （ES]3Ls） producing E. coli showed an annually upward trend （P〈0.01）, and the drug resistance rate of ESBLs-producing E. coli was higher than that of non ESBLs-producing E. coli （P〈0.01） ; in Chinese mainland, the isolated E. coli in the east had the lowest total resistance rate to the 4 types of antibiotics, and there was no significant difference between the drug resistance rates of the E. coli isolated from other regions. CONCLUSION The drug resistance rate of E. coli to cefu- roxime, ceftriaxone, levofloxacin and ciprofloxacin is rising year by year, so strengthening the management and standard use of antibiotics, and paying high attention to the control of nosocomial infections and continuous monitoring of ESBLs-producing E. coli will contribute to controlling the formation and proliferation of E. coli drug resistance.