1995-2003年上海地区10992株不动杆菌属临床分离菌的分布和耐药性分析

Surveillance for distribution and resistance of 10 992 Acinetobacter spp. isolates in Shanghai, 1995-2003

目的 :了解上海地区临床分离的不动杆菌属的耐药状况 ,为治疗该类细菌感染的抗菌药物选用提供依据。方法 :分析 1995年 1月 1日至 2 0 0 3年 12月 31日上海 11所医院不动杆菌属临床分离株的药敏试验资料 ,药敏试验采用Kirby Bauer法进行。结果 :9年间共分离不动杆菌属菌株 10 992株 ,其中 90 .3%分离自住院患者 ,9.7%分离自门诊患者。不动杆菌属在非发酵革兰阴性杆菌中所占比例为 35 %～ 37% ;其中鲍曼不动杆菌约占同年不动杆菌属总数的 72 .3%～ 78.6 %。不动杆菌属对亚胺培南、头孢哌酮 舒巴坦、氨苄西林 舒巴坦耐药率较低 ,对其他抗菌药物耐药率均较高 ,但因菌种不同而异。鲍曼不动杆菌对其他抗菌药物的耐药率均高 ,洛菲不动杆菌的耐药率较低 ,其他不动杆菌则介于两者之间。结论 :不动杆菌属是最重要的非发酵革兰阴性杆菌之一。不动杆菌属对亚胺培南、头孢哌酮 舒巴坦和氨苄西林 舒巴坦等耐药率较低 ,可根据病情选用于不动杆菌所致感染 ;其他各类抗菌药物耐药程度高 ,宜根据药敏试验结果选用。

Objective: To investigate the distribution and susceptibility of clinical isolates of Acinetobacter spp. in eleven Shanghai hospitals. Methods:Retrospectively analyze the antimicrobial susceptibility of clinical isolates from 1st January 1995 to 31st December 2003 which were tested by Kirby-Bauer method. Results:There were 10 992 Acinetobacter spp. clinical isolates in these 9 year, and 90.3% of them were isolated from hospitalized patients while 9.7% from outpatient subjects. The ratio of Acinetobacter spp. to nonfermentative gram-negative bacilli was 35%-37%. In Acinetobacter spp., 72.3%-78.6% isolates were A. baumanii. Results of susceptibility test showed that imipenem, cefoperazone-sulbactam, and ampicillin-sulbactam were the most active antibiotics against Acinetobacter spp., and the resistance rates were 1.2%-10.4%, 2.7%-9.0%, and 6.7%-25.0% respectively. Acinetobacter spp. were resistant to all the other tested antimicrobials and the rates varied with the species. Generally, A. baumannii was more resistant than A. lwoffii and the others. Conclusions:Acinetobacter spp. was one of the most important gram-negative nonfermentative bacilli. Imipenem, cefoperazone-sulbactam, and ampicillin-sulbactam were the most active agents against these bacteria, and could be used to resolve the infection according to the clinical patterns. Other antimicrobials had lower activity should be used on the result of susceptibility test.