临床分离革兰阴性杆菌对头孢哌酮-舒巴坦、亚胺培南、美罗培南和阿米卡星的耐药性变迁

摘要

目的：探讨临床分离革兰阴性杆菌对头孢哌酮‐舒巴坦、亚胺培南、美罗培南和阿米卡星的耐药性变迁。方法收集广西医科大学第一附属医院2008年1月—2013年12月临床分离的鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌。以大肠埃希菌 ATCC 25922和铜绿假单胞菌 ATCC 27853为细菌鉴定和药敏试验的质控菌株，采用VITEK‐2 Compact将细菌鉴定到种，参照美国临床和实验室标准化协会（CLSI）2013年标准，采用纸片扩散法检测鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对头孢哌酮‐舒巴坦、亚胺培南、美罗培南和阿米卡星的敏感性，采用WHONET 5．6软件进行数据分析处理。结果2008—2013年鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对头孢哌酮‐舒巴坦的耐药率分别从2．9％、5．5％、1．2％、2．8％和13．9％升至30．9％、21．2％、4．7％、11．2％和28．9％。鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和阴沟肠杆菌对亚胺培南的耐药率分别从18．3％、12．2％、0．8％和6．1％升至77．8％、20．8％、2．3％和6．4％；对美罗培南的耐药率分别从20．7％、11．4％、1．7％和9．4％升至78．3％、22．3％、3．8％和9．9％；鲍曼不动杆菌和铜绿假单胞菌对阿米卡星的耐药率从62．8％和11．3％升至93．5％和21．5％；大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对阿米卡星的耐药率从8．5％、17．1％和29．0％下降至4．1％、6．4％和23．6％。结论鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对头孢哌酮‐舒巴坦、亚胺培南、美罗培南的耐药率逐年增高，大肠埃希菌和肺炎克雷伯菌对阿米卡星的耐药率逐年下降。%Objective To investigate the changing resistance pattern of clinical isolates of gram‐negative bacilli to antimicrobial agents ,especially cefoperazone‐sulbactam ,imipenem ,meropenem and amikacin .Methods Isolates of Acinetobacter baumannii , Pseudomonas aeruginosa , Escherichia coli , K lebsiella pneumoniae and Enterobacter cloacae were collected from the First Affiliated Hospital of Guangxi Medical University from January 2008 to December 2013 . These strains were identified to species by VITEK‐2 Compact .Antibiotic susceptibility testing was carried out by Kirby‐Bauer method in accordance with CLSI 2013 criteria using E .coli(ATCC 25922)and P .aeruginosa(ATCC 27853)as reference strains .WHONET 5 .6 software was used for statistical analysis .Results During the five‐year period ,the cefoperazone‐sulbactam‐resistant strains of A .baumannii , P . aeruginosa , E . coli , K . pneumoniae and E . cloacae increased from 2 .9% ,5 .5% ,1 .2% ,2 .8% and 13 .9% to 30 .9% ,21 .2% ,4 .7% ,11 .2% and 28 .9% ,respectively . Imipenem‐resistant strains of A . baumannii , P . aeruginosa ,K . pneumoniae and E .cloacae increased from 18 .3% ,12 .2% ,0 .8% and 6 .1 % to 77 .8 % ,20 .8% , 2 .3% and 6 .4% ,respectively .Meropenem‐resistant strains of A .baumannii , P . aeruginosa , K . pneumoniae and E . cloacae increased from 20 .7% ,11 .4% ,1 .7% and 9 .4% to 78 .3% ,22 .3% ,3 .8% and 9 .9% ,respectively .Amikacin‐resistant strains of A .baumannii and P .aeruginosa increased from 62 .8% and 11 .3% to 93 .5% and 21 .5% ,respectively . Amikacin‐resistant strains of E .coli ,K .pneumoniae and E .cloacae decreased from 8 .5% ,17 .1% and 29 .0% to 4 .1% , 6 .4% and 23 .6% ,respectively .Conclusions A .baumannii ,P .aeruginosa ,E .coli ,K .pneumoniae and E .cloacae strains showed increasing resistance rates to cefoperazone‐sulbactam ,imipenem and meropenem from 2008 to 2013 .However ,E . coli ,K .pneumoniae and E .cloacae isolates demonstrated decreasing resistance rates to amikacin .