两种非发酵菌对多种抗菌药物耐药性的分析  

Antibiotics resistance of two non-fermentative bacteria

作　　者：方欢[1] 张军[1] 李刚[2] 袁轶群[2] 丁柳美[2] 

机构地区：[1]上海复旦大学附属金山医院药剂科,上海200032 [2]上海复旦大学附属金山医院检验科,上海200032

出　　处：《中华医院感染学杂志》2011年第9期1877-1880,共4页Chinese Journal of Nosocomiology

摘　　要：目的了解铜绿假单胞菌(PAE)和鲍氏不动杆菌(ABA)耐药的变化,探讨抗菌药物用药情况与耐药性之间关系,为合理使用抗菌药物提供依据。方法 2007年7月-2010年6月按季度对非发酵菌药敏试验结果和抗菌药物使用频度(DDDs)进行统计,以Spearman相关分析法进行分析。结果 PAE对除磺胺甲噁唑/甲氧苄啶外的抗菌药物敏感率均>70.0%,ABA 12个季度耐药率增长较大,其中亚胺培南和美罗培南耐药率最高,达到83.3%和88.9%;对于PAE,头孢吡肟DDDs不仅与自身耐药率相关(r=0.767),还与磺胺甲噁唑/甲氧苄啶的耐药率相关(r=0.772),喹诺酮类DDDs与亚胺培南耐药率相关(r=0.689);对于ABA,头孢美唑的DDDs与亚胺培南、美罗培南、庆大霉素和头孢噻肟耐药率相关(r=0.711、0.711、0.767和0.800);头霉素类的DDDs与亚胺培南、美罗培南、庆大霉素和阿米卡星的耐药率相关(r=0.826、0.788、0.633和0.642),头孢吡肟DDDs与头孢呋辛、头孢他啶、哌拉西林、磺胺甲噁唑/甲氧苄啶的耐药率相关(r=0.709、0.697、0.818和0.782);美罗培南DDDs不仅与自身耐药率相关(r=0.651),还与亚胺培南耐药率相关(r=0.679);PAE抗菌药耐药率间相关分析发现,只有磺胺甲噁唑/甲氧苄啶和头孢吡肟耐药不与其他抗菌药耐药率相关,对于ABA只有头孢美唑耐药率和其他抗菌药不存在相关。结论抗菌药使用量可以影响自身或其他抗菌药的耐药率;对于非发酵菌单纯控制抗菌药的使用,并不能减少其耐药率上升;耐药基因在菌株间横向传播可直接产生耐药,要控制耐药率增长,除合理使用抗菌药外,还必须控制医院感染,实行严格的隔离消毒制度。OBJECTIVE To periodically investigate resistance variation of Pseudomonas aeruginosa（PAE） and Acinetobacter baumannii（ABA）,correlation between resistance and antimicrobials consumption,and correlations among antimicrobials resistance of each non-fermentative bacteria.METHODS Results of antimicrobials sensitive test as well as DDDS of antibiotic were gathered and counted every quarter,and the data were analysed with the statistics method of Spearman rank correlation.RESULTS PAE kept a relatively high sensitivity to most antimicrobials,and ABA expressed an increasing ratio of drug resistance.For PAE,FEP DDDS was positively correlated to its resistance and the SXT resistance（r=0.767,0.772）,and Fluoroquinolone DDDS was positively correlated to IMP resistance（r=0.689）.For ABA,CMZ DDDS were positively correlated to IMP,MEM,GEN and CTX resistance（r=0.711,0.711,0.767 and 0.8）.Cephalomycin DDDS were positively correlated to IMP,MEM,and GEN and AMK resistance（r=0.826,0.788,0.633 and 0.642）.FEP DDDS were correlated to CXM,CAZ,PIP and SXT DDDs（r=0.709,0.697,0.818 and 0.782）.There were only FEP and SXT resistance without correlation to other antimicrobials resistance for PAE.For ABA just CMZ resistance had no correlation to others.CONCLUSION The doses of antibiotics can influence both their own resistance rates and the resistances to other antibiotics.The increasing resistance rate can not be prevented by using the single antibiotics to non-fermentative bacteria.The drug resistant genes,which can transmit horizontally through strains,can directly cause drug resistance,besides the reasonable application of antibiotics.We must control the nosocomail infection and implement the strict isolation and disinfection system to control the increasing drug resistant rate.

关 键 词：耐药性 铜绿假单胞菌 鲍氏不动杆菌 用药频度 

分 类 号：R978.1[医药卫生—药品]