摘要
目的调查我院2008-2010年临床分离的非重复腹腔感染革兰阴性菌的流行病学特点,对常用抗菌药物的耐药性以及产ESBLs比例,为指导临床治疗提供支持。方法药敏试验采用琼脂稀释法测定MIC;用WHONET 5.4软件及SPSS 13.0软件进行数据分析。结果临床分离的290株革兰阴性菌病原菌中,肠杆菌科细菌占82.07%;非发酵菌为17.93%。常见细菌有6种,其中大肠埃希菌占55.3%,鲍曼不动杆菌复合群所占比例明显升高(7.96%)。大肠埃希菌和肺炎克雷伯菌产ESBLs阳性率分别为74.38%和55.56%。大肠埃希菌对碳青霉烯类、派拉西林/他唑巴坦和阿米卡星高度敏感,但第3代头孢菌素和头孢吡肟耐药率很高。非ESBLs产酶肺炎克雷伯菌对常见12种抗G-细菌抗菌药物都很敏感,产ESBL菌株则对阿米卡星、派拉西林/他唑巴坦和碳青霉烯类比较敏感。铜绿假单胞菌对亚胺培南、派拉西林/他唑巴坦和阿米卡星的其敏感率均在90%以上;其次是头孢吡肟和2个氟喹诺酮类、其敏感率均在80%～90%之间;头孢拉定的敏感性下降到80%以下。鲍曼不动杆菌对碳青霉烯类抗菌药物的耐药率在80%以上。多重耐药菌占32%,主要菌种为鲍曼不动杆菌复合群和铜绿假单胞菌,80%MDR几乎对所有临床常用抗菌药物耐药。结论本地区腹腔感染革兰阴性菌对常用抗菌药物耐药性明显上升,产ESBLs肠杆菌细菌比例较高。鲍曼不动杆菌对常用抗菌药物耐药性很严重,泛耐药菌株比例上升。
Objective To investigate epidemiological characteristics of Gram-negative bacilli（GNB） isolated from patients with non-recurrent intra-abdominal infections in our hospitals from 2008 to 2010,and to analyze antimicrobial resistance of GNB to common antibiotics and ESBLs-producing ratio of GNB.Methods A total of 290 cases of GNB were isolated from patients with intra-abdominal infections from 2008 to 2010.In antimicrobial susceptibility test,agar dilution method was applied for MIC determination according to NCCLS guidelines.All the data were analyzed using WHONET 5.4 and SPSS 13.0.Results In the total of 290 GNB,enterobacteriaceae accounted for 82.7% and non-fermentative bacteria accounted for 17.93%.There were six types of common bacteria in which E.coli accounted for 55.3%,and the ratio of Acinetobacter baumannii complex increased apparently（7.96%）.The positive rates of ESBLs production in E.coli and Klebsiella spp were 74.38% and 55.56%,respectively.E.coli was highly sensitive to carbapenems,piperacillin/tazobaetam and amikacin,but not to the third-generation cephalosporins and cefepime.The non-ESBLs-producing Klebsiella spp was sensitive to the twelve common anti-GNB antibiotics,while ESBLs-producing Klebsiella spp was sensitive to amikacin,piperacillin/tazobaetam and carbapenems.The susceptibility rates of Pseudomonas aerltgillosa to imipenem,piperacillin/tazobaetam and amikacin were all above 90% and to cefepime and two quinolones were 80%to 90%,but the susceptibility rate to ceftazidime decreased below 80%.The drug resistance rate of Acinetobacter baumannii to carbapenems was above 80%.Multidrug resistant（MDR） strains accounted for 32%,mainly including Acinetobacter baumannii complex and Pseudomonas aerltgillosa.Eighty percent MDR strains were resistant to almost all commonly used antibiotics.Conclusion The antimicrobial resistance of GNB isolated from patients with intra-abdominal infections increases apparently during the past three years in the region,especially with a high proportion of ESBLs-producing enterobacteriaceae.Enterobacteriaceae and Pseudomonas aerltgillosa are highly sensitive to carbapenems,piperacillin/tazobaetam and amikacin,while Acinetobacter baumannii is resistant to all common antibiotics with an increased proportion of MDR strains.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2011年第21期2235-2239,共5页
Journal of Third Military Medical University
基金
重庆市自然科学基金(CSTC2008BB5393)
重庆市教育委员会科技项目(KJ100311)~~
关键词
腹腔感染
耐药监测
革兰阴性菌
抗感染治疗
Intra-abdominal infections
antibiotic resistance monitoring
Gram-negative bacilli
antibactorial therapy
