SEANIR监测中国15所教学医院不发酵糖革兰阴性杆菌对13种抗菌药物的药敏试验

摘要

目的 分析SEANIR监测2008年中国15所教学医院医院获得性不发酵糖革兰阴性杆菌对抗菌药物的敏感性,并评价帕尼培南体外药敏试验方法.方法 收集2008年分离自中国15所教学医院医院获得性感染患者的非重复鲍曼不动杆菌349株、铜绿假单胞菌359株、嗜麦芽窄食单胞菌145株和洋葱伯克霍尔德菌100株,用琼脂稀释法测定13种抗菌药物的MIC,对比MH培养基和1:40 MH培养基对帕尼培南药敏试验结果的影响.结果 鲍曼不动杆菌对碳青霉烯类抗生素的敏感率仅为51.6％～63.7％;多黏菌素B和米诺环素对鲍曼不动杆菌的体外抑菌活性最强,且对亚胺培南耐药鲍曼不动杆菌仍具有较高的抑菌率(分别98.1％和72.8％).多黏菌素B和阿米卡星对铜绿假单胞菌的抑菌率最高(分别为96.1％和83.3％),其次为用1:40MH培养基测定帕尼培南、哌拉西林-他唑巴坦和美罗培南的抑菌率(72.4％～77.2％).嗜麦芽窄食单胞菌和洋葱伯克霍尔德菌对米诺环素和甲氧苄啶-磺胺甲(恶)唑均较敏感(敏感率为78.6％～98.0％).结论 多黏菌素B对鲍曼不动杆菌和铜绿假单胞菌,米诺环素对鲍曼不动杆菌、嗜麦芽窄食单胞菌和洋葱伯克霍尔德菌,具有较强的体外抗菌活性.帕尼培南的体外药敏试验,鲍曼不动杆菌应采用MH培养基测定,铜绿假单胞菌应采用1:40 MH培养基测定,其抗菌作用与亚胺培南较为接近.%Objective To analyze the antimicrobial susceptibilities of nosocomial-acquired gram-negative non-fermentative bacteria in 15 teaching hospitals in China of SEANIR surveillance in 2008 and evaluate the susceptibility testing methodology of panipenem. Methods The non-duplicate strains of Acinetobacter baumannii (n= 349) , Pseudomonas aeruginosa (n = 359), Stenotrophomonas maltophilia (n = 145) and Burkholderia cepacia (n= 100)were collected from the inpatients with hospital-acquired infection. Antimicrobial susceptibility was determined by agar dilution method. Both MH and 1 : 40 MH medium were used when testing the susceptibility to panipenem. Results The percentage of A. baumannii susceptible to carbapenems ranged from 51.6% to 63. 7%. Poly-myxin B and minocycline showed the highest antimicrobial activity against A. baumannii. Even for the imipenem-resistant A. baumannii, there were still 98. 1% and 72. 8% of the strains susceptible to polymyxin B and minocycline. Polymyxin B and amikacin were the most active antibiotics against P. aeruginosa (96. 1 % and 83. 3% susceptible, respectively) , followed by panipenem determined with 1 : 40 MH, piperacillin-tazobactam and meropenem (72.4% to 77. 2% susceptible). Minocycline and trimethoprim-sulfamethoxazole were the most active antibiotics against S. maltophilia and B. cepacia (78. 6% to 77.2% susceptible). Conclusions Polymyxin B showed the highest antimicrobial activity against A. baumannii and P. aeruginosa. Minocycline was most active against A. baumannii , S. maltophilia and B. cepacia, MH medium should be used when testing the antimicrobial susceptibility of A. baumannii to panipenem, but for P. aeruginosa the 1 : 40 MH should be used.