2006至2011年某院革兰阴性杆菌对碳青霉烯类药物耐药性的变迁  

Resistance changes of carbapenem resistant Gram-negative bacteria isolated during 2006-2011

作　　者：马兰[1] 黄一灵 徐婷 顾兵 刘根焰 赵旺胜 文怡 梅亚宁 

机构地区：[1]南京市高淳县人民医院检验科,南京市211300 [2]南京医科大学第一附属医院检验学部

出　　处：《中华实验和临床感染病杂志（电子版）》2014年第6期13-16,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家自然基金项目(No.81000754);江苏省实验诊断学重点实验室重大课题(No.XK201114)

摘　　要：目的分析2006至2011年革兰阴性杆菌对碳青霉烯类药物的耐药及其变迁特点,为临床合理用药提供依据。方法收集2006至2011年分离的革兰阴性杆菌,采用法国生物梅里埃公司的VITEK-2全自动微生物分析系统或API细菌鉴定板条进行细菌鉴定到种;用纸片琼脂扩散法（KirbyBauer法）进行药物敏感试验;采用WHONET 5.6软件进行统计分析。结果 2006至2011年本院所分离细菌居前7位的是大肠埃希菌、铜绿假单胞菌、表皮葡萄球菌、肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌和白假丝酵母菌。鲍曼不动杆菌由2006年的第3位（7.7%）上升至2011年的第1位（17.9%）;大肠埃希菌由2006年的第1位（18.7%）下降至2011年的第3位（11.1%）。鲍曼不动杆菌对亚胺培南的耐药率由16.0%上升至90.8%,对美洛培南的耐药率由21.0%上升至91.1%;铜绿假单胞菌对亚胺培南和美洛培南的耐药率略有上升,分别为46.0%～62.5%和45.0%～63.7%;大肠埃希菌对亚胺培南的耐药率由2006年的0.7%上升至2010年的3.5%,而2011年下降至1.2%,对美洛培南的耐药率由2006年的1.3%上升至2010年的3.8%,而2011年下降至1.4%;肺炎克雷伯菌对亚胺培南的耐药率由2006年的2.6%上升至2011年的11.1%,对美洛培南的耐药率由2006年的0.9%上升至2011年的30.7%。结论鲍曼不动杆菌、肺炎克雷伯菌和大肠埃希菌对碳青霉烯类药物的耐药性上升迅速,应引起高度重视。Objectives To analyze the changes and characteristics of carbapenem resistant among Gram-negative bacteria isolated during 2006-2011, and provide the basis for the rational use of antibiotics. Methods Gram-negative bacteria isolated from 2006-2011 were collected. The bacteria were identified by VITEK-2 identification system or API bacterial identification strip. Antimicrobial susceptibility testing was carried out by disc diffusion method（Kirby-Bauer method）. Data analysis was performed by WHONET 5.6 software. Results Among the Gram-negative bacteria strains during 2006-2011, the top seven of isolating rates were Escherichia coli, Pseudomonas aeruginosa, Staphylococcus epidermidis, Klebsiella pneumonia, Staphylococcus aureus, Acinetobacter baumannii and Candida albicans. Acinetobacter baumannii rised from the third（7.7%） in 2006 to the first（17.9%） in 2011; Escherichia coli declined from the first（18.7%） in 2006 to the third（11.1%） in 2011. The resistant rate of Acinetobacter baumannii to imipenem raised from 16.0% to 90.8%, while the resistant rate to meropenem raised from 21.0% to 91.1%. The resistant rate of Pseudomonas aeruginosa to imipenem and meropenem were 46.0%-62.5% and 45.0%-63.7%, respectively. The resistant rates of Escherichia coli to imipenem raised from 0.7% in 2006 to 3.5% in 2010, then down to 1.2% in 2011; to meropenem raised from 1.3% in 2006 to 3.8 % in 2010, then decrease to 1.4% in 2011. The resistant rates of Klebsiella pneumonia to imipenem raised from 2.6% in 2006 to 11.1% in 2011; to meropenem raised from 0.9% in 2006 to 30.7% in 2011. Conclusions The resistant rates of Acinetobacter baumannii, Klebsiella pneumonia and Escherichia coli were increased significantly, which should be paid attention to.

关 键 词：碳青霉烯类 耐药性 革兰阴性杆菌 亚胺培南 美洛培南 

分 类 号：R446.5[医药卫生—诊断学]