1999～2002年北京、广东、湖北和辽宁地区大肠埃希氏菌及肺炎克雷伯氏菌临床分离株耐药性比较分析  

Study on antimicrobial resistance of Escherichia coli and Klebsiella pneumoniae isolates collected from hospitals in Beijing,Guangdong,Hubei and Liaoning Regions from the year 1999 to 2002

作　　者：马越[1] 李景云[1] 张新妹[1] 许明哲[1] 张力[1] 胡昌勤[1] 金少鸿[1] 

机构地区：[1]中国药品生物制品检定所国家细菌耐药性监测中心,北京100050

出　　处：《中国抗生素杂志》2004年第4期226-234,256,共10页Chinese Journal of Antibiotics

摘　　要：目的　调查 1999年～ 2 0 0 2年国家细菌耐药性监测网不同地区大肠埃希氏菌和肺炎克雷伯氏菌临床分离株的耐药性 ,比较不同来源菌株耐药率间的差别。方法　药物敏感性试验采用纸片扩散法 ,WHONET5软件进行结果分析。结果　四年间共收集大肠埃希氏菌 14 80 3株和肺炎克雷伯氏菌 792 3株。尿液、痰和血液等是大肠埃希氏菌和肺炎克雷伯氏菌临床分离株的主要标本来源。 1999～ 2 0 0 2年 ,北京、广东、湖北和辽宁地区大肠埃希氏菌临床分离株对亚胺培南最敏感 ,其次为头孢他啶和阿米卡星。在全部大肠埃希氏菌临床分离株中 ,广东地区的菌株对头孢噻肟的耐药率最高 ,2 0 0 2年增加到 37.2 %。环丙沙星的耐药率超过 5 0 % ,复方磺胺甲口恶唑和四环素的耐药率分别为 6 7.4 %～ 86 .0 %和 72 .3%～ 84 .4 %。肺炎克雷伯氏菌临床分离株对亚胺培南最敏感 ,其次为头孢吡肟、头孢他啶、阿米卡星和环丙沙星。 1999～ 2 0 0 2年 ,除北京分离菌株对头孢噻肟和头孢他啶的耐药率无明显变化外 ,广东、湖北和辽宁地区的分离菌株对头孢噻肟和头孢他啶的耐药率有明显增高 ,环丙沙星的耐药率也有一定程度的增高。湖北地区肺炎克雷伯氏菌临床分离株对氨曲南的耐药率四年间增加了 13.0 %。北京、广东、湖北和辽宁地区产超广谱 β-?Objective To investigate and compare the antimicrobial resistance of Escherichia coli and Klebsiella pneumoniae isolates collected from hospitals in different regions in national surveillance network. Methods Disc diffusion test was used to study the antimicrobial resistance, and WHONET 5 was applied for analysis of the antimicrobial resistance. Results In the period of study from the year 1999 to 2002, E.coli 14803 and K.pneumoniae 7923 were collected from different hospitals, most of strains were isolated from sputum , urine and blood. The isolates of E.coli from 4 regions were most susceptible to imipenem, followed by ceftazidime and amikacin. The rate of resistance of the strains of E.coli from Guangdong was highest among all isolates to cefotaxime,and increased to 37.2% in 2002. The resistant rates of all strains were over 50% to ciprofloxacin, 67.4%～86.0% and 72.3%～84.4% to trimethoprim/sulfamethoxazole and tetracycline, respectively. K.pneumoniae isolates were also most susceptible to imipenem, followed by cefepime ceftazidime, amikacin and ciprofloxacin. From 1999 to 2002, The resistant rates of the isolates of K.pneumoniae from Guangdong, Hubei and Liaoning significantly increased to cefotaxime and ceftazidime except for Beijing. The rate of resistance was increased to ciprofloxacin to some extent; and that of isolates from Hubei was increased 13% to aztreonam during the period. The incidences of extended-spectrum β-lactamases (ESBLs) producing strains gradually increased in the study period around the regions. In 2002, the incidences of ESBLs-producing strains of E.coli and K.pneumoniae from Guangdong and Hubei were 28.1% and 23.7%, and 23.1% and 27.7%, respectively. The resistant rate of ESBLs-producing strains was higher to cefotaxime than that to ceftazidime, which indicated most ESBLs belonged to CTX-M. Conclusions Antimicrobial resistance of E.coli and K.pneumoniae isolates threatens the successful treatment of infections. It is very important to rationally use antimicrobial agents and

关 键 词：大肠埃希氏菌 肺炎克雷伯氏菌 纸片扩散法 耐药率 超广谱Β-内酰胺酶 

分 类 号：R378[医药卫生—病原生物学]