摘要
目的 监测2014年中国革兰阴性杆菌的耐药性.方法 收集2014年3-8月全国15家教学医院的1 430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MIC.药敏结果判断采用临床和实验室标准化协会（CLSI） 2014年M100-S24标准.数据分析采用WHONET-5.6软件.结果 全部抗菌药物对964株肠杆菌科细菌的抗菌活性,敏感性依次为美罗培南（94.7％,913/964）、阿米卡星（94.4％,910/964）、亚胺培南（88.5％,853/964）、厄他培南（87.8％,847/964）、哌拉西林-他唑巴坦（87.2％,841/964）、头孢哌酮-舒巴坦（86.7％,836/964）、多黏菌素B（77％,742/964）、头孢吡肟（74.5％,718/964）、头孢他啶（71.8％,692/964）、左氧氟沙星（71.1％,685/964）、环丙沙星（67.7％,653/964）、米诺环素（64.2％,619/964）、头孢曲松（56.8％,548/964）、头孢噻肟（55.8％,538/964）、头孢西丁（45.5％,439/964）.产超广谱β内酰胺酶（ESBLs）的大肠埃希菌和肺炎克雷伯菌发生率分别为57.6％ （114/198）和24.6％（49/199）.对于大肠埃希菌,抗菌活性在80％以上的药物除碳青霉烯类之外,还有多黏菌素B（95.5％）、阿米卡星（94.4％）、哌拉西林-他唑巴坦（97.9％）和头孢哌酮-舒巴坦（83.3％）,而敏感率相对较低（＜40％）的药物有左氧氟沙星（39.4％）、环丙沙星（37.9％）、头孢曲松（33.8％）和头孢噻肟（33.8％）.肺炎克雷伯菌对多黏菌素B的敏感率最高（99.5％）,其次为阿米卡星（89.9％）、美罗培南（86.4％）、亚胺培南（86.4％）和哌拉西林-他唑巴坦（81.9％）,而敏感率较低的为头孢曲松（60.8％）和头孢噻肟（59.8％）.对阴沟肠杆菌、产气肠杆菌和弗劳地柠檬酸菌,抗菌活性最高的药物依次为阿米卡星（98.0％ ～98.4％）、美罗培南（96.1％ ～97.4％）、亚胺培南（95.1％～97.1％）、多黏菌素B（92.6％ ～99.0％）、头孢哌酮-舒巴坦（87.3％ ～92.6％）、厄他培南（82.7％ ～91.2％）、哌拉西林-他唑巴坦（79.4％ ～87.3％）.奇异变形杆菌、普通变形杆菌和摩根摩根菌对美罗培南、头孢哌酮-舒巴坦、哌拉西林-他唑巴坦、头孢吡肟的敏感率均大于90％.铜绿假单胞菌对多黏菌B敏感率最高为99.5％,其次为阿米卡星（92％）和环丙沙星（82.1％）.鲍曼不动杆菌对多黏菌素B的敏感率最高,为99.0％.对亚胺培南和美罗培南的敏感率分别为29.2％和28.2％,对米诺环素敏感率为67.0％,对头孢哌酮-舒巴坦敏感率为29.7％.头孢吡肟对肠杆菌科采用新折点后,大肠埃希菌敏感率下降了25.8％,其次阴沟肠杆菌敏感率下降了14.7％.结论 碳青霉烯类对肠杆菌科的抗菌活性有所下降,但与其他药物相比仍保持较高的抗菌活性.应警惕碳青霉烯耐药肠杆菌流行.新折点下肠杆菌科细菌对头孢吡肟敏感性有所降低.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更应值得关注。
Objective To investigate the current situation of antimicrobial resistance of nosocomial gram-negative bacilli in 2014 in China.Methods About 1 430 consecutive and non-repetitive strains of gram-negative bacilli were isolated from 15 teaching hospitals from March to August in 2014.All of these isolates were sent to the central laboratory for reidentification and susceptibility testing.The minimal inhibitory concentration （MIC）of meropenem and other antibacterial agents were determined by agar dilution method.The data were analyzed by using WHONET-5.6 software.Results The activity of antimicrobial agents against Enterobacteriaceae was listed as followings in descending order of susceptibility：meropenem （94.7%,913/964）,amikacin （94.4%,910/964）,imipenem （88.5%,853/964）,ertapenem （87.8%,847/964）,piperacillin-tazobactam （87.2%,841/964）,cefoperazone-sulbactam （86.7%,836/964）,polymyxin B （77%,742/964）,cefepime （74.5%,718/964）,cefiazidime （71.8%,692/964）,levofloxacin（71.1%,685/964）,ciprofloxacin （67.7%,653/964）,minocyline （64.2%,619/964）,ceftriaxone （56.8%,548/964）,cefotaxime （55.8%,538/964）,cefoxitin （45.5%,439/964）.The prevalence of extended-spectrum beta-lactamases （ESBLs） was 57.6% （114/198）in E.coli and 24.6% （49/199） in Klebsiella pneumonia.The sensitivity of E.coli to carbapenems,amikacin,piperacillin-tazobactam,polymyxin B and cefoperazone-sulbactam was all over 80%.However,over 60% E.coli strains were resistant to ciprofloxacin,levofloxacin,ceflriaxone and cefotaxime.Polymyxin B was the most susceptible antibiotic to Klebsiella pneumoniae （99.5% sensitive）,followed by amikacin （89.9%）,meropenem （86.4%）,imipenem （86.4%） and piperacillin-tazobactam （81.9%）,while ceftriaxone （60.8%） and cefotaxime （59.8%） were less sensitive.The activity of antimicrobial agents against E.cloacae,E.aerogenes and Citrobacter freundii was listed as followings in descending order of susceptibility：meropenem （96.1%-97.4%）,imipenem （95.l%-97.1%）,polymyxin B （92.6%-99.0%）,cefoperazone/sulbactam （87.3%-92.6%）,ertapenem （85.6%-93.3%）,piperacillin-tazobactam （65.0%-89.8%）.The susceptibility rates of meropenem,cefoperazone-sulbactam,piperacillin-tazobactam,cefepime to Proteus mirabilis,Proteus vulgaris and Morganella morganii were all more than 90.0%.The most active agents against Pseudomonas aeruginosa were polymyxin B （99.5%）,followed by amikacin （92.0%） and ciprofloxacin（82.1%）.A.baumanni was most susceptible to polymyxin B （99.0%）,while resistant to imipenem,meropenem and cefoperazone-sulbactam （29.2%,28.2% and 29.7% respectively）,mediate to minocycline （67.0%）.Based on the new breakpoints for cefepime to Enterobacteriaceae,the drug susceptible rates decreased 25.8% to E.coli and 14.7% to E.cloacae.Conclusions Carbapenems remain high susceptibility against Enterobacteriaceae,however carbapenem-resistant Enterobacteriaceae （CREs） have emerged.The sensitivity of Enterobacteriaceae against cefepime has been decreased according to the new breakpoint.Multi-drug resistant A.baumanni should be monitored persistently.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2015年第10期837-845,共9页
Chinese Journal of Internal Medicine
关键词
革兰氏阴性菌
耐药监测
Gram-Negative bacteria
Drug resistance
