院内常见革兰氏阴性杆菌耐药性监测  

Nosocomial surveillance of drug resistance of common Gram-negative bacilli

作　　者：陈冬梅[1] 陈求刚[1] 廖康[1] 建美[1] 曾燕[1] 罗兰[1] 

机构地区：[1]中山医科大学附属第一医院,广州510080

出　　处：《中国抗生素杂志》2001年第6期473-476,共4页Chinese Journal of Antibiotics

摘　　要：目的　了解本院常见的革兰氏阴性杆菌的耐药性 ,以及大肠埃希氏菌和肺炎克雷伯氏菌超广谱β-内酰胺酶 (ESBL s)菌株的发生率。方法　纸片扩散法 ,ESBL s菌株用头孢他啶 /克拉维酸、头孢噻肟 /克拉维酸进行确证。结果　 482株革兰氏阴性杆菌有 6 7株 ESBL s菌株 ,其中大肠埃希氏菌 46株 ,肺炎克雷伯氏菌2 1株 ,分别占该种菌的 38.9%、2 9.2 %。药敏检测结果显示 ,大肠埃希氏菌和肺炎克雷伯氏菌中产 ESBL s菌株敏感率由高到低排列为美罗培南 10 0 %、亚胺培南 10 0 %、头孢匹肟 6 7%、哌拉西林 /三唑巴坦 6 6 % ;不产ESBL s菌株敏感率由高到低排列为美罗培南和亚胺培南均为 10 0 %、头孢他啶 90 %、头孢曲松 85 %、头孢匹肟 84%、头孢噻肟、氨曲南、阿米卡星均为 82 %、哌拉西林 /三唑巴坦 73%。阴沟肠杆菌中除美罗培南、亚胺培南的敏感率均为 10 0 %外 ,其它抗生素敏感率低于 6 0 %。不动杆菌敏感率由高到低排列为亚胺培南 85 %、氧氟沙星 81%、美罗培南 75 %、阿米卡星 73%、环丙沙星 6 4%。铜绿假单胞菌敏感率较高的有美罗培南 90 %、亚胺培南 82 %、头孢匹肟 78%、头孢他啶 77%、哌拉西林 /三唑巴坦 73%、环丙沙星 6 8%、妥布霉素 6 3%、哌拉西林 6 1%。结论　本院产 ESBL s菌株以大肠埃希氏菌多见。?Objective: To evaluate the nosocomial drug resistance of the common Gram-negative bacilli and the incidence of extended spectrum β-lactamase (ESBL) strains of E.coli and K.pneumoniae. Methods: The ESBL producing strains were all confirmed by ceftazidime/clavulanic, and cefotaxime/clavulanic with disk diffusion method. Results: Among 482 strains of Gram negative bacilli, 76 strains of ESBL-positive strains including 46 of E.coli and 21 of K.pneumoniae were detected, the proportion of each two were 38.9% and 29.2% respectively. Microbial sensitivity tests results were arranged from high to low as follows: The sensitivity rates of ESBL-positive strains of E.coli and K.pneumoniae were meropenem 100%, imipenem 100%, cefepime 67% and piperacillin/tazobactam 66% respectively. The sensitivity rates of ESBL-negative of E.coli and K.pneumoniae were meropenem 99%, imipenem 98%, ceftazidime 90%, ceftriaxone 85%, cefepime 84%, cefotaxime 82%, aztreonam 82%, amkikacin 82% and piperacillin/tazobactam 73% respectively. The sensitivity rates of E.cloacae were lower than 60% but completely sensitive to imipenem and meropenem. The sensitivity rates of Acinetobacter were imipenem 85%, ofloxacin 81%, meropenem 75% and amikacin 73% respectively. P.aeruginosa had high susceptibility to meropenem 90%, imipenem 82%, cefepime 78%, ceftazidime 77%, piperacillin/tazobactam 73%, ciprofloxacin 68%, tobramycin 63% and piperacillin 61% respectively. Conclusions: E.coli was found to be a commonly present ESBL producing bacilli in our hospital. Gram negative bacilli (except S.maltophilia) were highly sensitive to meropenem, imipenem, piperacillin/tazobactam, cefepime.

关 键 词：革兰氏阴性杆菌 超广谱Β-内酰胺酶 ESBLS 药物敏感性试验 

分 类 号：R978.11[医药卫生—药品] R969[医药卫生—药学]