重症监护病房革兰阴性杆菌耐药性监测  

Survey of Gram-negative bacili resistance in intensive care unit

作　　者：曾爱中[1] 莫岚[1] 蒋玉富[1] 王其南[1] 

机构地区：[1]重庆医科大学附属一院传染科,400016

出　　处：《中国抗感染化疗杂志》2003年第1期19-20,共2页Chinese Journal of Infection and Chemotherapy

摘　　要：目的 :调查从我院重症监护病房 (ICU)患者中分离的革兰阴性杆菌耐药状况 ,并探讨对耐药菌感染的治疗策略。方法 :用E试验法测定 10 0株革兰阴性杆菌对 12种抗菌药的最低抑菌浓度 (MIC)。结果 :亚胺培南和头孢哌酮 舒巴坦对所有受试菌仍保持最高抗菌活性 ,细菌的耐药率分别为 9%和 11% ,哌拉西林 三唑巴坦、头孢吡肟次之 ,耐药率分别为 19%和2 1%。阿米卡星、头孢他啶、阿莫西林 克拉维酸的耐药率分别为 2 5 %、2 6 %和 30 %。其他抗菌药耐药率在 4 3%～ 5 4 %之间。头孢吡肟对铜绿假单胞菌抗菌活性最强 ,其敏感率达 89% ,头孢哌酮 舒巴坦、阿米卡星次之均为 84 % ,亚胺培南、头孢他啶敏感率分别为 79%和 74 %。筛选出超广谱 β内酰胺酶 (ESBLs)产生菌 19株 ,抗菌活性最强的是亚胺培南、头孢哌酮 舒巴坦和哌拉西林 三唑巴坦 ,敏感率分别为 84 .1%、78.9%、和 6 8.4 %。结论 :亚胺培南可作为ESBLs产生菌所致重症感染的首选药物 ,而 β内酰胺酶抑制剂与 β内酰胺酶类抗生素的复合制剂可作为治疗产 β内酰胺酶耐药株感染的选用药物之一。Objective: To investigate the Gram negative bacterial resistance rates in ICU and discuss how to treat infections caused by these resistant strains. Methods: The minimal inhibitory concentration (MIC) of 12 antibiotics against 100 strains of Gram negative bacilli isolated from ICU patients were determined by E test. Results: The resistance rates to imipenem and cefoperazone sulbactam were the lowest, being 9% and 11% respectively. The resistance rates to piperacillin tazobactam and cefepime were slightly higher, being 19% and 21%, respectively. The resistance rates to other antibiotics tested were ranging from 25% to 54%. Cefepime has the highest susceptible rates of 89% against Pseudomonas aeruginosa. Nineteen ESBLs producing strains were susceptible to imipenem,cefoperazone sulbactam and piperacillin tazobactam. Conclusion: The resistance rates of gram negative bacilli isolated from ICU patients to commonly used antibiotics were very high. Imipenem is the most active agent against severe systemic infections caused by ESBLs producing strains, while β lactam /β lactamase inhibitors are also active against most strains also preferred.

关 键 词：革兰阴性杆菌 药物耐受 抗菌药 E试验 超广谱Β内酰胺酶 

分 类 号：R446.5[医药卫生—诊断学]