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2012年中国13家教学医院革兰阴性杆菌耐药监测分析 被引量:27

Antimicrobial resistance of Gram-negative bacilli isolated from 13 teaching hospitals across China
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摘要 目的监测2012年中国革兰阴性杆菌的耐药性。方法收集2012年3—8月全国13家教学医院的1247株非重复革兰阴性杆菌。菌株经中心实验室复核后,采用琼脂稀释法测定美罗培南等广谱抗菌药物的最低抑菌浓度(MIC)。药敏结果判断采用美国临床及实验室标准协会(CLSI)2012年M100-S22标准。数据分析采用WI-IONET-5.6软件。结果871株肠杆菌科细菌对全部抗菌药物的敏感性由高到低依次为美罗培南(97.5%,849/871)、阿米卡星(94.5%,823/871)、亚胺培南(93.6%,815/871)、厄他培南(92.9%,809/871)、哌拉西林/他唑巴坦(89.9%,783/871)、头孢哌酮/舒巴坦(83.5%,727/871)、头孢吡肟(78.1%,680/871)、多黏菌素B(77.0%,670/871)、头孢他啶(69.6%,606/871)、左氧氟沙星(69.2%,603/871)、环丙沙星(63.6%,554/871)、米诺环素(63.1%,550/871)、头孢曲松(55.7%,485/871)、头孢噻肟(54.2%,472/871)、头孢西丁(51.4%,448/871)。产超广谱B内酰胺酶(ESBL)的大肠埃希菌和肺炎克雷伯菌发生率分别为64.3%(117/182)和32.1%(60/187)。大肠埃希菌对美罗培南、亚胺培南敏感率为100%,对厄他培南、阿米卡星、哌拉西林/他唑巴坦和多黏菌素B也保持较好的敏感性(〉99%),而对环丙沙星、左氧氟沙星、头孢曲松和头孢噻肟的耐药率较高(〉60%)。肺炎克雷伯菌对美罗培南、亚胺培南、阿米卡星和多黏菌素B的敏感率均保持在90%以上,而对头孢噻肟和头孢曲松的耐药率较高,分别为40.1%(75/187)和39.6%(74/187)。对阴沟肠杆菌、产气肠杆菌、弗劳地柠檬酸杆菌,抗菌活性高的药物依次为美罗培南(96.0%~100%)、亚胺培南(96.O%~100%)、多黏菌素B(95.8%~100%)、阿米卡星(92.2%~100%)、厄他培南(85.6%~93.3%)、头孢吡肟(77,8%~93.3%)、头孢哌酮/舒巴坦(78.4%~90.0%)、哌拉西林/他唑巴坦(65.0%~89.8%)。鲍曼不动杆菌对多黏菌素B的敏感率最高,为100%;对亚胺培南和美罗培南的敏感率分别为37.8%o(65/172)和36.0%(62/172),对米诺环素敏感率为62.8%(108/172)。对于铜绿假单胞菌敏感性较高的药物为多黏菌素B(97.2%,173/178)、其次为阿米卡星(89.3%,159/178)和头孢他啶(83.7%,149/178)。2012年CLSI修订了铜绿假单胞菌部分药敏折点,与2011年CLSI折点相比较,铜绿假单胞菌对哌拉西林/他唑巴坦的敏感率由83.7%(149/178)变为77.5%(138/178),对美罗培南的敏感率由78.1%(139/178)变为71.3%(127/178),对亚胺培南的敏感率由69.7%(124/178)变为59.6%(106/178),修订折点后3种药物的敏感率均有下降。多重耐药鲍曼不动杆菌和铜绿假单胞菌发生率分别为65.7%(113/172)和9.0%(16/178)。结论碳青霉烯类对肠杆菌科仍保持较高活性,但鲍曼不动杆菌耐药性仍居高不下。多重耐药鲍曼不动杆菌高发生率应值得关注。新折点对铜绿假单胞菌的抗菌药物敏感度影响明显。 Objective To explore the antimicrobial resistance of nosocomial Gram-negative bacilli across China. Methods A total of 1247 consecutive and non-repetitive Gram-negative bacilli were isolated from 13 Chinese teaching hospitals from March to August 2012. All isolates were sent to a central laboratory for reidentifieation and susceptibility testing. The minimal inhibitory concentration (MICs)of meropenem and other antibacterial agents were determined by agar dilution method. And the data were analyzed with WHONET-5.6 software. Results The activity of antimicrobial agents against Enterobacteriaceae was in the following descending order of susceptibility rate : meropenem ( 97. 5 %, 849/871 ), amikacin (94. 5 %, 823/ 871 ), imipenem (93.6%, 815/871 ), ertapenem (92. 9%, 809/871 ), piperaeillin/tazobactam ( 89.9%, 783/871 ), cefoperazone/sulbactam ( 83.5%, 727/871 ), cefepime (78.1%, 680/871 ), polymyxin B (77. 0% , 670/871 ), eefiazidime ( 69. 6%, 606/871 ), levofloxacin ( 69.2% , 603/871 ), ciprofloxacin (63.6%, 554/871 ), minocyline (63.1%, 550/871), ceftriaxone (55.7%, 485/871 ), eefotaxime (54. 2% , 472/871 ) and cefoxitin(51.4% , 448/871 ). The prevalence of extended-spectrum beta-lactamase ESBL) was 64. 3 4o ( 117/182 ) in Escherichia coli( E. coli) and 32. 1% ( 60/187 )in Klebsiellapneumonia (K. pneurnoniae). The sensitivities of E. coli to meropenem and imipenem were 100%. And over 90% of E. coli was sensitive to ertapenem, amikaein, piperaeillin/tazobaetam and polymyxin B. However, over 60% of E. coli was resistant to ciprofloxaein, levofloxaein, ceftriaxone and eefotaxime. The susceptibility of K. pneumoniae to meropenem, imipenem, amikacin and polymyxin B maintained at over 90%. The activities of antimicrobial agents against E. cloacae, E. aerogenes and Citrobacter freundii were in the following descending order of susceptibility rate : meropenem ( 96. 0% - 100% ) , imipenem ( 96.0% - 100% ), polymyxin B ( 95.8% - 100% ), amikacin ( 92. 2% - 100% ), ertapenem ( 85.6% - 93.3% ), cefepime ( 77. 8% - 93.3% ), cefoperazone/sulbactam ( 78.4% - 90. 0% ) and piperacillin/tazobaetam (65.0% -89.8% ). The most susceptible agent against Acinetobacter baumannii (A. baumannii) was polymyxin B( 100% ). The susceptibilities of A. baumannii to imipenem, raeropenem and minocyline were 37.8% (65/172), 36. 0% (62/172) and 62. 8% (108/172) respectively. The most active agents against Pseudomonas aeruginosa ( P. aeruginosa ) were polymyxin B ( 97.2%, 173/178 ), followed by amikacin (89.3% , 159/178 ) and cefiazidime ( 83.7% , 149/178 ) . Clinical and Laboratory Standards Institute revised P. aeruginosa susceptibility standard in 2012. The sensitivity of piperacillin/tazobactam changed from 83.7% ( 149/178)to 77. 5% (138/178). The sensitivity of meropenem decreased from 78. 1% ( 139/178 ) to 71.3% ( 127/178 ) while that of imipenem declined from 69. 7% ( 124/178)to 59. 6% (106/178). The prevalence of multi-drug resistant A. baumannii and P. aeruginosa were 65.7 % (113/172) and 9.0% ( 16/178) respectively. Conclusions Carbapenems remain highly active against Enterobacteriaceae. Increasing resistance of A. baumanni to all antimierobial agents is noted. New breakpoint to P. aeruginosa has obvious effects on antimicrobial sensitivity.
出处 《中华医学杂志》 CAS CSCD 北大核心 2013年第18期1388-1396,共9页 National Medical Journal of China
关键词 抗药性 细菌 微生物敏感性试验 革兰阴性杆菌 耐药监测 Drug resistance, bacterial Microbial sensitivity tests Gram-negative bacilli Drug resistance monitoring
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