呼吸病区下呼吸道革兰阴性杆菌连续5年耐药性监测  

Surveillance of antimicrobial resistance in gram-negative bacilli isolated from lower respiratory tract of patients in respiratory wards for 5 consecutive years

作　　者：叶枫[1] 钟淑卿[1] 袁锦屏[1] 杨灵[1] 钟南山[1] 

机构地区：[1]广州呼吸疾病研究所,510120

出　　处：《中国感染与化疗杂志》2009年第2期129-133,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨本所呼吸病区患者下呼吸道分离革兰阴性杆菌的耐药变迁,指导临床合理使用抗菌药物。方法2003—2007年从呼吸病区患者下呼吸道分离的非重复的1 709株革兰阴性杆菌,采用Kirby-Bauer法进行药敏试验,数据分析采用WHONET5.4软件。结果最常见的病原菌为铜绿假单胞菌(43.7%)、肺炎克雷伯菌(11.1%)、嗜麦芽窄食单胞菌(9.2%)和鲍曼不动杆菌(9.0%)。铜绿假单胞菌对头孢哌酮-舒巴坦的耐药率最低,其次是阿米卡星(10.1%～27.7%)和美罗培南(17.3%～31.8%)。嗜麦芽窄食单胞菌对头孢哌酮-舒巴坦(5.9%～17.9%)和左氧氟沙星(7.1%～17.4%)的耐药率较低。亚胺培南和美罗培南对鲍曼不动杆菌保持较强的抗菌活性,头孢哌酮-舒巴坦对该菌的耐药率(0～22.2%)明显低于替卡西林-克拉维酸(17.4%～50.0%)和哌拉西林-他唑巴坦(16.7%～61.5%)。肠杆菌科细菌对亚胺培南和美罗培南仍高度敏感,对氟喹诺酮类药物的耐药率较高,且各品种间呈交叉耐药。肺炎克雷伯菌对头孢吡肟(0～32.6%)和头孢哌酮-舒巴坦(2.4%～38.1%)的耐药率明显低于第三代头孢菌素(11.9%～69.0%)。肺炎克雷伯菌产ESBLs株检出率由2003年的16.1%上升至2005年的76.7%,2007年降至28.6%,而大肠埃希菌产ESBLs株检出率则由2003年的45.5%上升至2007年的80.6%。产ESBLs菌株对大多数β内酰胺类抗生素高度耐药。结论细菌耐药率明显升高,加强耐药性监测,合理使用抗菌药物非常重要。Objective To investigate the change pattern of antimicrobial resistance among gram-negative bacilli isolated from lower respiratory tract for rational antibiotic therapy in clinical practice. Methods Antimicrobial susceptibility of 1 709 isolates of gram-negative bacilli from 2003 to 2007 was tested by disk diffusion （K-B） method. Whonet 5.4 software was used to analyze the data. Results The most common pathogens were Pseudomonas aeruginosa （43.7%）, Klebsiella pneumoniae （11. 1%）, Stenotrophomonas maltophilia （9.2 %） and Acinetobacter baumannii （9.0%）. Resistance rate of P. aeruginosa was relatively lower to cefoperazone-sulbactam, amikacin （10.1%-27.7%） and meropenem （17.3% -31.8%）. Resistance rate of S. maltophilia was relatively lower to cefoperazone-sulbactam （5.9%-17.9%） and levofloxacin （7.1%-17.4%）. Most of A. baumannil isolates were susceptible to imipenem and meropenem. Resistance rate of A. baumannii isolates to cefoperazone-sulbactam （0-22.2%） was lower than ticarcillin-clavulanic acid （17.4%-50.0%） and piperacillin- tazobactam （16.7%-61.5%）. Isolates of Enterobacteriaceae were still highly sensitive to imipenem and meropenem, but highly resistant to fluoroquinolones. Resistance rate of K. pneumoniae was lower to cefepime （0- 32.6 %） and cefoperazone-sulbactam （2.4 %-38.1 % ） than the third generation cephalosporins （11.9%-69.0%）. The prevalence of extended-spectrum β-1actamases （ESBLs） in K. pneumoniae increased from 16.1% in 2003 to 76.7% in 2005, but decreased to 28.6% in 2007, while in Escherichia coli the prevalence increased from 45.5% in 2003 to 80.6% in 2007. ESBLs-produeing strains were resistant to most β-lactams and some other antimicrobial agents. Conclusions Most pathogens show significant resistance to the most commonly used antibiotics. It is very important to select antibiotics for the treatment of infections based on the results of susceptibility testing in respiratory wards.

关 键 词：革兰阴性杆菌 耐药监测 耐药性 

分 类 号：R446.5[医药卫生—诊断学]