13种抗生素对革兰阴性杆菌抗菌活性及耐药性分析

Antibiotic activity of 13 antibiotics against gram negative bacilli and their drug-resistance analysis

目的 :研究临床常用抗生素的体外抗菌活性 ,分析其耐药特点 ,为临床合理用药提供可靠依据。方法 :对本实验室分离的 316株革兰阴性杆菌进行了体外药敏分析 ,并测定其产 β 内酰胺酶及超广谱 β 内酰胺酶的百分率。结果 :头孢哌酮 /舒巴坦 (舒普深CFS)的MIC90 为 8mg/L ;依米配能 /西司他丁 (泰能IPM)的MIC90 为 4mg/L ,耐药率分别为 8%和 16 % ;而其他抗生素的MIC90 为 12 8mg/L或 2 5 6mg/L ,耐药率均大于 30 %。细菌 β 内酰胺酶总检出率为 5 4 1% ,超广谱 β 内酰胺酶 (ESBL)检出率为 12 1%。结论 :CFS和IPM对临床常见革兰阴性杆菌耐药率较低。由于持续高产量 β 内酰胺酶及超广谱β 内酰胺酶的产生 ,不仅使得三代头孢菌素的耐药率较高 ,也使得庆大霉素、阿米卡星和环丙沙星等抗生素出现较为严重的交叉耐药现象。建议临床医生在三代头孢菌素的使用上应参考实验室报告 ,合理选择 ,避免耐药菌株的产生。

Aim:To study the drug resistance and antibiotic activity of common ontibiotics in vitro.Methods:The drug sensitive test was used to analyse 316 isolated gram negative strains with their enzyme activity also being detected(β lactmases and extended spectrum β lactamases).Results:The drug resistance rates of Cefp/sulbact(CFS) and imipenem cilactatin(IPM) were 8% and 16%,respectively,while that of the others was all higher than 30%.The MIC 90 (minium inhibitory 90% strains' concentration)of Cefp/sulbact(CFS)and imipenem cilactatin(IPM) were 8 mg/L and 4 mg/L while those of the others were 128 mg/L or 256 mg/L.The detection rate of β lactamases and extended spectrum β lactamases(ESBL) were 54.1% and 12.1%.Conclusion:CFS and IMP has lower drug resistance against gram negative bacilli.Drug resistance has increased in 3 genertion Cephalothin's and cross drug resistance has been seriously risen among Gentamicin,Amikacin.It is suggested that the choice of 3 generation Cephalothin should be contious and based on experimental reports in order to avoid the drug resistance of common antibiotics.