2009―2011年本院多重耐药革兰阴性菌的耐药性变迁及对多黏菌素B的体外敏感性  

Drug resistance variation of multidrug- resistant Gram-negative bacteria in our hospital during 2009—2011 and antibacterial activities of polymyxin B in vitro

作　　者：任玉涵[1] 袁喆[1] 黄文祥[1] 李崇智[1] 肖亮[1] 李佳俊[1] 刘婷婷[1] 

机构地区：[1]重庆医科大学附属第一医院感染科重庆市传染病寄生虫病重点实验室,重庆400016

出　　处：《中国新药与临床杂志》2014年第11期845-849,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：重庆市自然科学基金(CSTC2009BB5061);人事部科研基金(09958013)

摘　　要：目的分析重庆医科大学附属第一医院2009--2011年多重耐药革兰阴性菌的耐药性变迁并测定多黏菌素B及临床常用抗菌药物对其的体外抗菌活性，为临床制定合理的用药方案提供实验室依据。方法采用K－B法筛选出155株临床分离的多重耐药革兰阴性菌（53株鲍曼不动杆菌、50株肺炎克雷伯菌、52株铜绿假单胞菌），以琼脂稀释法测定其对多黏菌素B、亚胺培南等13种药物的敏感性及MIC值．数据采用Whonet5．6及SPSS18．0进行分析。结果琼脂稀释法与K－B纸片法得出的三种多重耐药革兰阴性菌的耐药率无显著差异（P〉0．05）。鲍曼不动杆菌对亚胺培南、美罗培南耐药率为58．3％，68．2％，对其他抗菌药物耐药率为48．5％～100％。肺炎克雷伯菌对亚胺培南、美罗培南耐药率小于9．4％，对阿米卡星、哌拉西林－他唑巴坦耐药率为8．6％～15．9％，对头孢他啶、头孢吡肟耐药率为34．8％～41．8％，对哌拉西林耐药率为46．3％～55．2％。铜绿假单胞菌对头孢他啶、头孢吡肟和亚胺培南耐药率为12．8％～30．7％。多黏菌素B对3种多重耐药革兰阴性菌保持着96％以上的抗菌活性，MIC_50和MIC_90均〈1mg·L^-1。结论本院多重耐药革兰阴性菌对临床常用抗菌药物的耐药已非常普遍，而多黏菌素B对其仍保持较高的抗菌活性。AIM To study the trend of antibiotic resistance of multi- drug resistant Gram- negative bacteria in our hospital from 2009 to 2011 and to investigate antibacterial activity of polymyxin B and clinical commonly used agents against multi-drug resistant Gram-negative bacteria in vitro, so as to provide guidance for clinical use of antibiotic drugs. METHEODS A total of 155 strains multi-drug resistant gram-negative bacteria were isolated by the Kirby- Bauer disk diffusion, in which, Acienetobacter baumanii were 53, Klebsiella pneumoniae were 50, Pseudomonas aeruginosa were 52. The susceptibility and minimum inhibitory concentrations （MICs） of 13 antibacterial drugs including polymyxin B and imipenem against these 155 strains were determined by the Kirby-Bauer disk diffusion and agar dilution method. Results were evaluated on the basis of CLSI 2011. WHONET 5.6 and SPSS18.0 softwares were used to analyze the data. RESULTS The antibiotic resistant rates of multi-drug resistant Gram-negative bacteria has no significantly difference between the two methods （P 〉 0.05）. The drug resistance rate of Acinetobacter baumannii to imipenem and meropenem were 58.3% to 68.2%. While for the rest of the agents, the drug resistance rates were 48.5% to 100%. Klebsiella pneumoniae showed the drug resistance rate as less than 9.4% against imipenem, between 8.6% to 15.9% against amikacin and piperacillin- tazobactam, and 34.8% to 41.8% against ceftazidime, cefepime. To piperacillin the drug resistance rates were 46.3% to 55.2%. The resistance rate of Pseudomonas aeruginosa against ceftazidime, cefepime and imipenem were 12.8% to 30.7%. Three kinds of multi-drug resistant Gram-negative bacteria were sensitive to polymyxin B and sensitive rates were more than 96%. MIC_50 and MIC_90 were less than 1 mg·L^-1. CONCLUSION The drug resistance of multi-resistant Gram-negative bacteria against commonly antibiotic agents has been very pervasive in our hospital, while polymyxin B still had strong antibacterial activity against multi- drug

关 键 词：多黏菌素B 革兰阴性菌 多重耐药菌 微生物敏感性试验 

分 类 号：R978.1[医药卫生—药品]