不同地区4家医院临床分离菌株对吉米沙星、左氧氟沙星和莫西沙星的耐药性分析

Resistance Analysis of Clinical Isolates from Four Hospitals in Different Regions to Jemefloxacin, Levofloxacin and Moxifloxacin

目的:了解国内不同地区4家医院临床分离菌株对吉米沙星、左氧氟沙星和莫西沙星的耐药性,为临床合理使用氟喹诺酮类抗菌药物提供参考。方法:收集2015年四川省人民医院、复旦大学附属华山医院、广州医科大学附属第一医院和甘肃省人民医院临床分离菌株,参照2016年美国临床和实验室标准协会相关要求,采用E试验测定细菌对抗菌药物的敏感性。采用纸片法筛选和酶抑制剂增强确证试验检测大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌和奇异变形杆菌中产超广谱β-内酰胺酶(extended spectrum β-lactamase,ESBL)菌株。结果:共收集到临床分离菌株539株,其中大肠埃希杆菌120株,肺炎克雷伯菌117株,肺炎链球菌108株,流感嗜血杆菌111株,卡他莫拉菌83株。大肠埃希菌对吉米沙星、左氧氟沙星的耐药率分别为56.7%、48.3%,其中产ESBL菌株对吉米沙星、左氧氟沙星的耐药率分别为66.7%、62.2%,非产ESBL菌株对吉米沙星、左氧氟沙星的耐药率分别为41.5%、34.0%。肺炎克雷伯对吉米沙星、左氧氟沙星的耐药率分别为36.8%、19.7%,其中产ESBL菌株对吉米沙星、左氧氟沙星的耐药率分别为81.6%、39.5%,非产ESBL菌株对吉米沙星、左氧氟沙星的耐药率分别为14.7%、12.1%。肺炎链球菌对吉米沙星、左氧氟沙星和莫西沙星的耐药率分别为2.8%、4.6%和2.8%;吉米沙星、左氧氟沙星和莫西沙星对流感嗜血杆菌的MIC_(90)范围为0.5～0.75μg/ml,左氧氟沙星、莫西沙星对流感嗜血杆菌的敏感率分别为100%、93.7%;吉米沙星对卡他莫拉菌的MIC_(50)、MIC_(90)分别为0.016、0.125μg/ml。结论:大肠埃希菌和肺炎克类伯菌对氟喹诺酮类抗菌药物的耐药率较高,但肺炎链球菌、流感嗜血杆菌和卡他莫拉菌对上述3种氟喹诺酮类抗菌药物高度敏感。

OBJECTIVE:To investigate the resistance of clinical isolates from four hospitals in different regions of China to jemefloxacin,levofloxacin and moxifloxacin,so as to provide references for clinical rational application of fluoroquinolones.METHODS:Clinical isolated strains in People’s Hospital of Sichuan Province,Huashan Hospital Affiliated to Fudan University,the First Affiliated Hospital of Guangzhou Medical University and People’s Hospital of Gansu Province in 2015 were collected,based on related requirements of American Association of Clinical and Laboratory Standards (2016 Edition),E-test was conducted to detect the sensitivity of bacteria against antibiotics.Paper-based screening and enzyme inhibitor enhanced confirmation test was adopted to detect extended spectrum β-lactamase (ESBL) strains in Escherichia coli,Klebsiella pneumoniae,Klebsiella oxytoca and Proteus mirabilis.RESULTS:A total of 539 clinical isolated strains were collected,of which 120 strains were E.coli,117 strains were K.pneumoniae,108 strains were streptococcus pneumoniae,111 strains were Haemophilus influenzae and 83 strains were Moraxella catarrhalis.The drug resistance rates of E.coli against gemifloxacin and levofloxacin were respectively 56.7% and 48.3%,of which the drug resistance rates of ESBL strains against gemifloxacin and levofloxacin were respectively 66.7% and 62.2%,while those of non-ESBL strains were respectively 41.5% and 34.0%.The drug resistance rates of K.pneumoniae against gemifloxacin and levofloxacin were respectively 36.8% and 19.7%,of which the drug resistance rates of ESBL strains against gemifloxacin and levofloxacin were respectively 81.6% and 39.5%,while those of non-ESBL strains were respectively 14.7% and 12.1%.The drug resistance rates of S.pneumoniae against gemifloxacin,levofloxacin and moxifloxacin were respectively 2.8%,4.6% and 2.8%;the MIC 90 of H.influenzae against gemifloxacin,levofloxacin and moxifloxacin ranged from 0.5 μg/ml to 0.75 μg/ml,the sensitive rates of H.influenzae against levofloxacin and moxifloxacin were respectively 100% and 93.7%;the MIC 50 and MIC 90 of M.catarrhalis against gemifloxacin were respectively 0.016 μg/ml and 0.125 μg/ml.CONCLUSIONS:The drug resistance rates of E.coli and K.pneumoniae against fluoroquinolones are relatively high,while S.pneumoniae,H.influenzae and M.catarrhalis are highly sensitive to the above 3 kinds of fluoroquinolones.