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目的监测2005年我国不同地区15家教学医院分离的医院获得革兰阴性病原菌的耐药性。方法按设计方案收集非重复的1927株院内获得革兰阴性病原菌。菌株经中心实验室复核后,采用琼脂稀释法测定6类18种抗菌药物的最低抑菌浓度(MIC),数据输入 WHONET 5.4软件进行耐药性分析。结果不产超广谱β内酰胺酶(ESBEs)的大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌对被测β内酰胺类药物的敏感性均较高,而对于产 ESBLs 的大肠杆菌和肺炎克雷伯菌,敏感率大于80%的药物只有美罗培南、亚胺培南和哌拉西林-三唑巴坦。不产 ESBLs 大肠埃希菌对氟喹诺酮类药物的敏感性很低(34.8%～36.1%),产 ESBLs 大肠埃希菌的敏感性则更低(13.4%～17.1%)。对于易产头孢菌素酶(AmpC)的菌株(包括阴沟肠杆菌、产气肠杆菌、枸橼酸杆菌属、沙雷菌属、普通变形杆菌),敏感率均大于80%的抗生素有美罗培南、亚胺培南、哌拉西林-三唑巴坦,另外,敏感性较高的抗菌药物还包括头孢吡肟(67.3%～100%)、阿米卡星(67.3%～95.2%)、头孢他啶(52.9%～100%)和头孢哌酮-舒巴坦(51.9%～100%),氟喹诺酮类药物的敏感率为52.5%～86.2%。铜绿假单胞菌对多黏菌素 B 的敏感性最高(95.6%),敏感率在70%～80%之间的药物有美罗培南、亚胺培南、阿米卡星和哌拉西林-三唑巴坦。鲍曼不动杆菌对多黏菌素 B 的敏感率达98.3%,继之为亚胺培南(80.8%)、美罗培南(76.2%)和米诺环素(67.4%),其他药物的敏感率低于60%。对嗜麦芽窄食单胞菌,敏感性较高的抗菌药物有米诺环素(85.0%)、左氧氟沙星(82.5%)和甲氧苄啶-磺胺甲噁唑(77.5%)。对洋葱伯克霍尔德菌,敏感性相对较高的抗菌药物有米诺环素(77.2%)和美罗培南(61.4%)。结论碳青酶烯类、哌拉西林-三唑巴坦、阿米卡星和头孢吡肟对医院分离的肠杆菌科菌保持了较高的抗菌活性,而非发酵革兰阴性杆菌对临床常用药物的敏感性较以往监测有所降低。
Objective To monitor the resistance of gram-negative pathogens in hospitals isolated from 15 teaching hospitals in different areas in China in 2005. Methods According to the design scheme, 1927 non-repetitive isolates of Gram-negative pathogens in the hospital were collected. The strains were subjected to central laboratory review, the minimum inhibitory concentration (MIC) of 6 classes and 18 kinds of antibacterials were determined by agar dilution method, and the data were input into WHONET 5.4 software for drug resistance analysis. Results Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis which did not produce extended-spectrum β-lactamases (ESBEs) were highly sensitive to β-lactams. However, ESBLs-producing Escherichia coli And Klebsiella pneumoniae, meropenem, imipenem and piperacillin-tazobactam were the only drugs that were more than 80% sensitive. The ESBLs-producing Escherichia coli was less sensitive to fluoroquinolones (34.8% -36.1%) and ESBLs-producing Escherichia coli was lower (13.4% -17.1%). For strains susceptible to cephalosporin (AmpC) (including Enterobacter cloacae, Enterobacter aerogenes, Citrobacter spp, Serratia, Proteus vulgaris), antibiotics with a sensitivity of greater than 80% were meropenem , Imipenem and piperacillin-tazobactam. In addition, the more sensitive antibacterials included cefepime (67.3% -100%), amikacin (67.3% -95.2%), ceftazidime (52.9% ~ 100%) and cefoperazone-sulbactam (51.9% ~ 100%). The sensitivity of fluoroquinolones was 52.5% ~ 86.2%. Pseudomonas aeruginosa had the highest sensitivity to colistin B (95.6%), and meropenem, imipenem, amikacin and piperacillin- Tazobactam. Acinetobacter baumannii sensitive to polymyxin B was 98.3%, followed by imipenem (80.8%), meropenem (76.2%) and minocycline (67.4%), the sensitivity of other drugs The rate is below 60%. For the Stenotrophomonas maltophilia, the most sensitive antibacterials were minocycline (85.0%), levofloxacin (82.5%) and trimethoprim-sulfamethoxazole (77.5%). For the Burkholderia cepacia, the most sensitive antimicrobials were minocycline (77.2%) and meropenem (61.4%). Conclusions Carbapenems, piperacillin-tazobactam, amikacin and cefepime have high antibacterial activities against Enterobacteriaceae isolated in the hospital, whereas non-fermentative gram-negative bacilli are commonly used in clinical practice The sensitivity of the drug is lower than the previous monitoring.