临床分离革兰阴性杆菌对头孢哌酮-舒巴坦、亚胺培南、美罗培南和阿米卡星的耐药性变迁

Changing resistance pattern of clinical gram-negative bacilli isolates to antimicrobial agents

目的探讨临床分离革兰阴性杆菌对头孢哌酮-舒巴坦、亚胺培南、美罗培南和阿米卡星的耐药性变迁。方法收集广西医科大学第一附属医院2008年1月—2013年12月临床分离的鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌。以大肠埃希菌ATCC 25922和铜绿假单胞菌ATCC 27853为细菌鉴定和药敏试验的质控菌株,采用VITEK-2 Compact将细菌鉴定到种,参照美国临床和实验室标准化协会(CLSI)2013年标准,采用纸片扩散法检测鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对头孢哌酮-舒巴坦、亚胺培南、美罗培南和阿米卡星的敏感性,采用WHONET5.6软件进行数据分析处理。结果 2008—2013年鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对头孢哌酮-舒巴坦的耐药率分别从2.9%、5.5%、1.2%、2.8%和13.9%升至30.9%、21.2%、4.7%、11.2%和28.9%。鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和阴沟肠杆菌对亚胺培南的耐药率分别从18.3%、12.2%、0.8%和6.1%升至77.8%、20.8%、2.3%和6.4%;对美罗培南的耐药率分别从20.7%、11.4%、1.7%和9.4%升至78.3%、22.3%、3.8%和9.9%;鲍曼不动杆菌和铜绿假单胞菌对阿米卡星的耐药率从62.8%和11.3%升至93.5%和21.5%;大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对阿米卡星的耐药率从8.5%、17.1%和29.0%下降至4.1%、6.4%和23.6%。结论鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对头孢哌酮-舒巴坦、亚胺培南、美罗培南的耐药率逐年增高,大肠埃希菌和肺炎克雷伯菌对阿米卡星的耐药率逐年下降。

Objective To investigate the changing resistance pattern of clinical isolates of gram‐negative bacilli to antimicrobial agents ,especially cefoperazone‐sulbactam ,imipenem ,meropenem and amikacin .Methods Isolates of Acinetobacter baumannii , Pseudomonas aeruginosa , Escherichia coli , K lebsiella pneumoniae and Enterobacter cloacae were collected from the First Affiliated Hospital of Guangxi Medical University from January 2008 to December 2013 . These strains were identified to species by VITEK‐2 Compact .Antibiotic susceptibility testing was carried out by Kirby‐Bauer method in accordance with CLSI 2013 criteria using E .coli（ATCC 25922）and P .aeruginosa（ATCC 27853）as reference strains .WHONET 5 .6 software was used for statistical analysis .Results During the five‐year period ,the cefoperazone‐sulbactam‐resistant strains of A .baumannii , P . aeruginosa , E . coli , K . pneumoniae and E . cloacae increased from 2 .9% ,5 .5% ,1 .2% ,2 .8% and 13 .9% to 30 .9% ,21 .2% ,4 .7% ,11 .2% and 28 .9% ,respectively . Imipenem‐resistant strains of A . baumannii , P . aeruginosa ,K . pneumoniae and E .cloacae increased from 18 .3% ,12 .2% ,0 .8% and 6 .1 % to 77 .8 % ,20 .8% , 2 .3% and 6 .4% ,respectively .Meropenem‐resistant strains of A .baumannii , P . aeruginosa , K . pneumoniae and E .＆amp;nbsp;cloacae increased from 20 .7% ,11 .4% ,1 .7% and 9 .4% to 78 .3% ,22 .3% ,3 .8% and 9 .9% ,respectively .Amikacin‐resistant strains of A .baumannii and P .aeruginosa increased from 62 .8% and 11 .3% to 93 .5% and 21 .5% ,respectively . Amikacin‐resistant strains of E .coli ,K .pneumoniae and E .cloacae decreased from 8 .5% ,17 .1% and 29 .0% to 4 .1% , 6 .4% and 23 .6% ,respectively .Conclusions A .baumannii ,P .aeruginosa ,E .coli ,K .pneumoniae and E .cloacae strains showed increasing resistance rates to cefoperazone‐sulbactam ,imipenem and meropenem from 2008 to 2013 .However ,E . coli ,K .pneumoniae and E .cloacae isolates demonstrated decreasing resistance rates to amikacin .