2002年临床常见革兰氏阴性杆菌耐药性监测

摘要

Objective To investigate the antimicrobial resistance among clinical isolates of Gramnegative bacteria in national surveillance network including 57 tertiary hospitals located in 8 provinces,metropolitans and municipalities. Methods Disc diffusion test (K-B method) was used to study the antimicrobial resistance, and WHONET 5 was applied for analysis. Results During the period of study in 2002,24826 Gram-negative bacteria strains were collected from patients. Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae were the most common strains among the isolates. Major specimens were sputum(47.9%), urine (16.8%) as well as wounds and secretions (10.4%). Most of Enterobacteriaceae isolates were susceptible to both imipenem and meropenem, and in declined order to third-generation cephalosporins and to combinations with β-lactamase inhibitor as well as amikacin. More than 15% (15.6%～ 51.2%)isolates of Enterobacter spp. , Citrobacter spp. , Serratia spp. and Providencia spp. were resistant to the third generation cephalosporins. Except for E. coli, less than 30% (6.0%～29.7%) of other Enterobacteriaceae isolates were resistant to ciprofloxacin and levofloxacin. In addition, the incidences of E. coli and K. pneumoniae producing extended spectrum β-lactamase isolates were 18. 2% and 22.6%, respectively. 19.1% and 15. 2 % of Pseudomonas aeruginosa isolates were resistant to imipenem and meropenem, the isolates of Acinetobacter baumannii were susceptible to carbapenems, but resistant rates of them were high to cefoperazone,ceftazidime and amikacin with 52.8%, 41.6% and 31.8%, respectively. Conclusions Antimicrobial resistance of clinical isolates threatens the successful treatment of infections. It is very important to promote the national program for the rational use of antimicrobial agents so that resistance is minimized and to take effective measures so that to curb the spread of antimicrobial resistance.%目的调查国家细菌耐药性监测网临床常见革兰氏阴性杆菌对各种抗菌药物的耐药性现状.方法药物敏感性试验采用纸片扩散法,耐药性数据分析采用WHONET5软件.结果2002年国家细菌耐药性监测网8个省、市、自治区的57家三级甲等医院共收集患者首次分离株24826株;大肠埃希氏菌、铜绿假单胞菌和肺炎克雷伯氏菌是最常见菌.主要标本为痰、尿和伤口及分泌物,分别占全部标本的47.9%,16.8%和10.4%.绝大多数肠杆菌科细菌对亚胺培南和美罗培南敏感,其次为第三代头孢菌素、含酶抑制剂的头孢菌素及阿米卡星.15%(15.6%～51.2%)的肠杆菌、柠檬酸杆菌、沙雷氏菌和普罗威登氏菌对第三代头孢菌素耐药.除大肠埃希氏菌外,环丙沙星和左氧氟沙星对其他肠杆菌科细菌的耐药率低于30%(6.0%～29.7%);产超广谱β-内酰胺酶(ESBLs)的大肠埃希氏菌和肺炎克雷伯氏菌株的检出率分别为18.2%和22.6%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为19.1%和15.2%.鲍氏不动杆菌对碳青霉烯类抗生素较敏感,但对头孢哌酮、头孢他啶和阿米卡星的耐药率分别为52.8%,41.6%和31.8%.结论细菌耐药性问题是抗感染治疗的主要威胁,合理使用抗菌药物以降低耐药性和采取有效措施控制其传播是非常重要的.