目的：分析昆明医科大学第一附属医院新生儿重症监护室（N IC U ）肠杆菌科细菌耐药性变迁。方法收集该医院NICU 2010—2013年分离的648株肠杆菌科细菌，采用VITEK‐2及纸片扩散（K‐B）法进行药敏试验，试验结果以美国临床和实验室标准化协会（CLSI）2012年版为判断标准。结果该院 NICU 分离的肠杆菌科细菌中最常见的是大肠埃希菌（47．4％）、克雷伯菌属（38．1％）和肠杆菌属（10．3％）。标本主要来源于尿液（51．2％）、呼吸道（30．6％）和血液（15．1％）。肠杆菌科细菌对阿米卡星敏感率最高，为95．7％，对美罗培南、厄他培南和亚胺培南的敏感率平均分别为92．3％、90．9％和87．6％，对左氧氟沙星、环丙沙星、庆大霉素敏感率平均分别为87．1％、79．2％、69．0％，对头孢吡肟平均敏感率72．7％，对第三代头孢菌素平均敏感率低于56．0％。产超广谱β内酰胺酶（ESBL ）大肠埃希菌、克雷伯菌属检出率平均分别为46．3％、54．7％且呈逐年上升趋势。产ESBL菌株对大多数抗菌药物的敏感率低于非产ESBL菌株；但克雷伯菌属产ESBL菌株对碳青霉烯类抗生素敏感性显著高于非产ESBL株。共分离到对碳青霉烯类抗生素耐药菌株51株，主要为肺炎克雷伯菌。该类菌株对亚胺培南、美罗培南和厄他培南的耐药率分别为83．7％、60．5％和95．3％。结论该院NICU肠杆菌科细菌ESBL的检出率较高，耐碳青霉烯类菌株不断出现，应引起高度关注。%Objective To investigate the changing pattern of bacterial resistance of Enterobacteriaceae isolates from the Neonatal Intensive Care Unit of the first Affiliated Hospital of Kunming Medical University during the period from 2010 to 2013 . Methods A total of 648 clinical isolates of Enterobacteriaceae were collected .Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby‐Bauer method or VITEK‐2 automated system . The susceptibility data were interpreted according to the Clinical and Laboratory Standards Institute(2012) breakpoints and were processed with WHONET 5 .6 software .Results The top three commonly isolated bacteria were Escherichiacoli(47 .4% ) ,Klebsiellaspp .(38 .1% ) ,and Enterobacter spp .(10 .3% ) .The primary source of the bacteria was urine ,respiratory tract and blood . Enterobacteriaceae isolates showed the highest susceptibility to amikacin (95 .7% ) ,followed by carbapenems ,meropenem (92 .3% ) ,ertapenem (90 .9% ) and imipenem (87 .6% ) .About 87 .1% ,79 .2% ,and 69 .0% of the isolates were susceptible to levofloxacin , ciprofloxacin ,and gentamicin on average .Overall ,72 .7% of the Enterobacteriaceae isolates were susceptible to cefepime ,and less than 56 .0% were susceptible to the third generation cephalosporins . ESBLs‐producing strains accounted for 46 .3% in E .coli and 54 .7% in K lebsiella spp . ESBLs‐producing Enterobacteriaceae strains were generally more resistant than non‐ESBLs‐producing strains in terms of antibiotic resistance rate . However , ESBLs‐producing K lebsiella strains were less resistant to carbapenems than non‐ESBLs‐producing strains . A total of 51 carbapenem‐resistant Enterobacteriaceae strains were identified , primarily K lebsiella pneumoniae .Most of these 51 strains were resistant to imipenem (83 .7% ) ,meropenem (60 .5% ) and ertapenem (95 .3% ) . Conclusions ESBLs‐producing and carbapenem‐resistant Enterobacteriaceae strains are highly prevalent in the Neonatal Intensive Care Unit of this Hospital .The increasing emergence of carbapenem‐resistant Enterobacteriaceae strains is an issue of concern .
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