159株致败血症革兰阴性菌对β内酰胺类抗生素的药敏分析  

Susceptibility toβ-lactams of 159 strains gram-negative bacilli cultured from blood of patients with septicemia

作　　者：朱晓娜[1] 王邦松[1] 李庆兴[1] 陈迎晓[1] 张慧芳[1] 张永虎[1] 

机构地区：[1]温州医学院附属第一医院感染内科,温州325000

出　　处：《中国临床药学杂志》2008年第4期216-220,共5页Chinese Journal of Clinical Pharmacy

摘　　要：目的测定致败血症革兰阴性菌对β内酰胺类抗生素的药物敏感性,为临床治疗提供参考。方法1999年3月- 2007年6月间经血培养证实革兰阴性败血症的病例141例,检出菌株159株,以VITEK-AMS全自动微生物鉴定仪进行药敏试验。结果革兰阴性菌菌株对氨苄西林耐药率最高,达86.13%,对氨苄西林/舒巴坦、头孢唑啉、头孢噻吩的耐药率均在50%以上;对哌拉西林/三唑巴坦、头孢哌酮钠/舒巴坦钠、亚胺培南/西司他丁、美罗培南等较敏感,耐药率均低于10%;超广谱β内酰胺酶(ESBLs)检出率达32.84%,ESBLs阳性菌株对头孢唑林、头孢噻肟、头孢他啶、头孢曲松、氨曲南的耐药率明显高于ES- BLs阴性菌株,差异有统计学意义(P<0.05)。结论败血症革兰阴性致病菌对碳青霉烯类、头孢哌酮/舒巴坦钠及哌拉西林/三唑巴坦等抗菌药物敏感性高。产生ESBLs是革兰阴性菌对β内酰胺类抗生素耐药的原因之一。AIM To determine susceptibility to β-lactams of gram-negative bacilli of septicemia, and to offer a direction for clinical therapy. METHODS One hundred and fifty-nine strains of gram-negative bacteria were collected from patients with septicemia during Mar. 1999 - Jun. 2007. Drug sensitivity tests of ^-lactams were measured. RESULTS In gram-negative isolates, the antibiotics with the high resistance rate were ampicillin （86.13 % ）, cefalotin（72.97 % ）, cefazolin （59.38%） and ampiciUin/sullbactam （52.94%） respectively. While antibiotics with the low resistance rate were cefoperazone/sulbactam （2.63 % ）, memopenem （4.76 % ）, imipenem/cilastatin （5.60 % ） and piperacillin/tazobactam （9.09%） respectively. The detection rate of gram-negative isolates which produced extended spectrum beta-lactamases （ESBI-s） was 32.84%, while which of E. coli and K. pneumoniae were 38.64% and 25%, respectively. The gramnegative isolates producing ESBI_s had higher drug resistance to cefazolin, cefotaxime, ceftazidime, ceftriaxone, aztreonam than that of ESBLs negative isolates （ P 〈 0.05）. CONCLUSION Gram-negative bacilli have high sensitivity to cefoperazone/sulbactam, meraopenem, imipenem/cilastatin and piperacillin/tazobactam. ESBIs-producing is one reason of drug resistance to β-lactams.

关 键 词：败血症 革兰阴性菌 Β内酰胺类抗生素 耐药率 

分 类 号：R446.5[医药卫生—诊断学]