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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

Antimicrobial resistance of Gram-negative bacilli isolated from 13 teaching hospitals across China

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WHONET-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β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(>90%),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(96.0%~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%(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.

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abstracts:

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 reidentification 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),piperacillin/tazobactam (89.9%,783/871),cefoperazone/sulbactam (83.5%,727/871),cefepime (78.1%,680/871),polymyxin B (77.0%,670/871),cefiazidime (69.6%,606/871),levofloxacin (69.2%,603/871),ciprofloxacin (63.6%,554/871),minocyline (63.1%,550/871),ceftriaxone (55.7%,485/871),cefotaxime (54.2%,472/871) and cefoxitin (51.4%,448/871).The prevalence of extended-spectrum beta-lactamase (ESBL) was 64.3 % (117/182) in Escherichia coli (E.coli) and 32.1% (60/187) in Klebsiella pneumonia (K.pneumoniae).The sensitivities of E.coli to meropenem and imipenem were 100%.And over 90% of E.coli was sensitive to ertapenem,amikacin,piperacillin/tazobactam and polymyxin B.However,over 60% of E.coli was resistant to ciprofloxacin,levofloxacin,ceftriaxone and cefotaxime.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/tazobactam (65.0%-89.8%).The most susceptible agent against Acinetobacter baumannii (A.baumannii) was polymyxin B(100%).The susceptibilities of A.baumannii to imipenem,meropenem 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 antimicrobial agents is noted.New breakpoint to P.aeruginosa has obvious effects on antimicrobial sensitivity.

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