非发酵菌对亚胺培南的耐药性分析  

Non-fermenting Gram Negative Bacilli Resistant to Imipenem

作　　者：丁玎 吕火祥[2] 

机构地区：[1]温岭市第一人民医院,浙江台州3175002 [2]浙江省人民医院,浙江杭州310014

出　　处：《中华医院感染学杂志》2004年第8期926-928,共3页Chinese Journal of Nosocomiology

摘　　要：目的　分析临床分离的亚胺培南耐药的非发酵菌的分布及耐药性 ,探讨合理使用抗菌药物。方法　用VITEK32微生物自动鉴定仪鉴定细菌到种 ,采用配套的GNS 12 0卡测定 12种抗菌药物的敏感性 ,同时对所有细菌采用琼脂扩散法检测头孢哌酮 /舒巴坦和美罗培南的耐药情况 ,并用EDTA协同抑菌试验检测金属 β 内酰胺酶的产生。结果　共分离到亚胺培南耐药的非发酵菌 4 4株 ,占全部非发酵菌 35 8% ;标本来源以呼吸道标本为主 ,病区以ICU为主 ,菌种以铜绿假单胞菌最多 2 5株 ,脑膜脓毒性金黄杆菌次之 8株 ,所有耐亚胺培南的非发酵菌有 5 2 3%产金属 β 内酰胺酶 ;细菌对抗菌药物的耐药性以头孢哌酮 /舒巴坦最低 (38 6 % ) ,其次为哌拉西林 /他唑巴坦 (6 8 2 % )和美罗培南 (72 7% )。结论　产金属 β 内酰胺酶是非发酵菌对亚胺培南耐药的重要原因 ;对于亚胺培南耐药的非发酵菌经验治疗可首选头孢哌酮 /舒巴坦 ;充分认识非发酵菌的耐药特点 ,针对性地使用抗菌药物。OBJECTIVE To analyze the distribution and resistance of non-fermenting Gram negative bacilli resistant to imipenem isolated from patients and explore how to administrate appropriate antibiotics. METHODS We identified the microorganisms and tested their susceptibility to 12 antibiotics with VITEK 32 GNI+ and GNS-120 cards. Furthermore, we tested their resistance to cefoperazone/sulbactam and meropenem by K-B method, and detected the metalo-beta-lactamase by EDTA synergism inhibition tests. RESULTS We isolated 44(35.8%) strains non-fermenting Gram negative bacilli resistant to imipenem and the majority came from respiratory tract specimens of patients in intensive care unit (ICU). They were Pseudomonas aeruginosa (n=25) and Chryseobacterium meningosepticum (n=8) and others. In these strains there were 52.3% producing metalo-beta-lactamase. Cefoperazone/sulbactam were with the lowest percentage of resistance(38.6%), others were piperacillin/tazobactam (68.2%) and meropenem (72.7%). CONCLUSIONS Metalo-beta-lactmase producton is the important cause of resistance of non-fermenting Gram negative bacilli to imipenem. Cefoperazone sulbactam may be the first-choice antibiotics. So the key to infection prevention and therapy of non-fermenting Gram negative bacilli resistant to imipenem is to know the resistance and choose the appropriate antibiotics to delay resistance occurring.

关 键 词：非发酵菌 亚胺培南耐药 金属Β-内酰胺酶 

分 类 号：R969.4[医药卫生—药理学]