老年患者医院获得性肺炎耐药性临床分析

目的 分析老年患者医院获得性肺炎致病菌的菌群分布及其对抗生素的耐药情况,为临床合理使用抗生素提供依据.方法 对我院2006年6月至2009年9月160例老年患者医院获得性肺炎的临床资料进行回顾性分析,明确病原学特点及对抗生素的耐药情况.结果 共分离出180株病原菌,其中革兰阴性菌108株(60.0%),革兰阳性菌48株(26.7%),真菌24株(13.3%).革兰阴性菌中铜绿假单胞菌检出率最高(20.5%),革兰阳性菌中金黄色葡萄球菌检出率最高(11.1%).长期使用抗生素、广谱抗生素的慢性患者真菌检出率增高.革兰阴性杆菌对三代头孢菌素均耐药,产超广谱β内酰胺酶的大肠埃希菌、肺炎克雷伯菌对青霉素类、青霉素+酶抑制剂、头孢菌素类和单酰胺类抗生素均耐药,铜绿假单胞菌耐药严重,但对头孢他啶尚敏感.革兰阴性菌对阿米卡星、哌拉西林+他唑巴坦、头孢哌酮+舒巴坦、亚胺培南、美洛培南的敏感性较高.耐甲氧西林金黄色葡萄球菌(MRSA)占92.6%,革兰阳性菌对阿奇霉素、环丙沙星、氨苄西林、氨苄西林+舒巴坦的耐药率多在76%以上,而对万古霉素、利奈唑胺、替考拉宁敏感性高,尚未发现耐万古霉素、利奈唑胺、替考拉宁的葡萄球菌菌株.结论 老年患者医院获得性肺炎以革兰阴性杆菌为优势菌株,产超广谱β内酰胺酶的大肠埃希菌、肺炎克雷伯菌呈逐年增高趋势,且耐药性日趋严重,其对阿米卡星、哌拉西林+他唑巴坦、头孢哌酮+舒巴坦、亚胺培南、美洛培南敏感性较高.革兰阳性球菌感染宜用万古霉素、利奈唑胺或替考拉宁.     

哌拉西林-舒巴坦等七种药物对非发酵菌体外抗菌活性的研究

目的 评价哌拉西林-舒巴坦等7种药物对非发酵菌的体外抗菌活性.方法 采用微量肉汤稀释法测定哌拉西林-舒巴坦对细菌的体外抗菌作用.结果 广州地区6家医院共收集菌株770株,其中铜绿假单胞菌216株,鲍曼不动杆菌242株,嗜麦芽窄食单胞菌100株,洋葱伯克霍尔德菌119株,黄杆菌属57株,产碱杆菌属36株.对所有铜绿假单胞菌,哌拉西林-舒巴坦的敏感性最高(71.9%),而亚胺培南、头孢吡肟、头孢他啶、头孢哌酮-舒巴坦敏感性均低于50%.对亚胺培南不敏感的铜绿假单胞菌,哌拉西林-舒巴坦敏感性仍可达55.8%.对碳青霉烯敏感的鲍曼不动杆菌,哌拉西林-舒巴坦和头孢哌酮-舒巴坦敏感性最高,分别为71.0%和73.0%.对嗜麦芽窄食单胞菌,26%和20%的菌株对哌拉西林-舒巴坦和哌拉西林-他唑巴坦的最低抑菌浓度(MIC)≤16 mg/L.对洋葱伯克霍尔德菌,69%的菌株对哌拉西林-舒巴坦的MIC≤16 mg/L.对黄杆菌属和产碱杆菌属,哌拉西林-舒巴坦、头孢哌酮-舒巴坦和哌拉西林他唑巴坦3种加酶复合制剂敏感性最高,分别为70.2%、63.2%、57.9%和94.4%、94.4%、91. 7%.结论 哌拉西林-舒巴坦对多种非发酵菌尤其是碳青霉烯不敏感的铜绿假单胞菌具有良好的体外抗菌活性.     

老年科下呼吸道感染病原菌耐药性分析

目的了解我院老年科下呼吸道感染常见病原菌的感染现状及耐药性规律。方法采用API鉴定系统鉴定细菌及真菌,纸片扩散法测定细菌药物敏感性,Rosco纸片法测定真菌药物敏感性,WHONET 5.4软件进行统计分析。结果我院老年科痰培养阳性率为15.7%,检出率最高的前3位病原菌是铜绿假单胞菌、肺炎克雷伯菌及不动杆菌。葡萄球菌属未发现万古霉素耐药株,但对其他多种抗菌药物耐药;肠杆菌科细菌对美洛培南、亚胺培南、头孢哌酮舒巴坦和哌拉西林他唑巴坦较敏感,但大肠埃希菌及阴沟肠杆菌对喹诺酮类药物敏感性下降;非发酵菌中铜绿假单胞菌对药物的敏感性为美洛培南、亚胺培南〉头孢他定〉哌拉西林他唑巴坦〉头孢哌酮舒巴坦,未检出耐碳青霉烯类的鲍曼不动杆菌。结论我院老年科下呼吸道感染病原菌以杆菌为主,对多种抗菌药物耐药率较高,应引起重视并合理选择抗菌药物。     

302例疑诊耳部感染性疾病患者局部分泌物细菌培养结果及其药物敏感性分析

目的分析302例疑诊耳部感染性疾病患者中耳及外耳分泌物标本的细菌培养结果及其药物敏感性。方法 302例疑诊耳部感染性疾病患者,取患者中耳、外耳分泌物标本共313份(中耳214份,外耳99份),进行细菌培养、鉴定及药敏试验。结果共分离出致病菌207株,病原菌检出率依次为金黄色葡萄球菌42株(13.4%)、铜绿假单胞菌33株(10.5%)、真菌(7.3%)、表皮葡萄球菌22株(7.0%)。药敏试验结果显示金黄色葡萄球菌对万古霉素、利奈唑胺、替加环素、呋喃妥因、奎奴普汀/达福普汀、利福平、莫西沙星敏感,对青霉素G、红霉素、克拉霉素的耐药率依次为88.1%、78.6%、76.2%;铜绿假单胞菌对比阿培南、哌拉西林/他唑巴坦、亚胺培南、阿米卡星敏感,对氨苄西林/舒巴坦、复方新诺明、头孢唑啉、头孢曲松、头孢替坦、呋喃妥因的耐药率均达100.0%;表皮葡萄球菌对万古霉素、利奈唑胺、替加环素、喹奴普汀/达福普汀、利福平、替考拉宁敏感,对青霉素G、红霉素、苯唑西林的耐药率依次为90.9%、90.5%、90.5%。结论耳部感染性疾病患者的主要致病细菌为金黄色葡萄球菌、铜绿假单胞菌、表皮葡萄球菌。金黄色葡萄球菌主要对万古霉素、利奈唑胺、替加环素敏感,对青霉素G、红霉素、克拉霉素耐药;铜绿假单胞菌主要对比阿培南、哌拉西林/他唑巴坦、亚胺培南、阿米卡星敏感,对氨苄西林/舒巴坦、复方新诺明、头孢唑啉、头孢曲松、头孢替坦、呋喃妥因耐药;表皮葡萄球菌主要对万古霉素、利奈唑胺、替加环素敏感,对青霉素G、红霉素、苯唑西林耐药。     

387例急性脑梗死合并肺部感染患者病原菌分布及耐药性分析

目的检测和分析急性脑梗死合并肺部感染患者的病原菌分布以及耐药性,为合理使用抗菌药物提供依据。方法收集2012年1月至2018年6月在本院进行诊治并符合急性脑梗死患者合并肺部感染诊断标准的患者387例,对其痰标本进行细菌培养,并检测分析其耐药性。结果 387例急性脑梗死合并肺部感染患者临床标本共培养出431株病原菌,其中革兰阴性菌(G-)304株,占70.53%;革兰阳性菌(G+)98株,占22.74%;真菌29株,占6.73%。G-菌中检出率较高的次为肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌。其中肺炎克雷伯菌对哌拉西林他唑巴坦、头孢哌酮舒巴坦、亚胺培南具有较高的敏感性,对氨苄西林、左氧氟沙星具有较高的耐药性;铜绿假单胞菌对哌拉西林他唑巴坦、头孢哌酮舒巴坦、头孢吡肟、亚胺培南、氨曲南较敏感,对氨苄西林、头孢唑林、左氧氟沙星耐药率为79.41%-86.76%;大肠埃希菌对哌拉西林他唑巴坦、头孢哌酮、头孢哌酮舒巴坦、亚胺培南较敏感,对头孢唑林、左氧氟沙星耐药率为85.71%-96.43%。G+菌中检出率较高的是金黄色葡萄球菌和表皮葡萄球菌,两细菌对利奈唑胺、替考拉宁、呋喃妥因、万古霉素较敏感,对青霉素、氨苄西林耐药率为81.48%-100.00%;真菌中检出率较高的是白色假丝酵母菌和热带假丝酵母菌,两真菌对酮康唑、制霉菌素、氟胞嘧啶较敏感,对氟康唑、伊曲康唑和两性霉素B耐药率为26.67%-40.00%。结论急性脑梗死合并肺部感染患者感染病原菌普遍存在一定的耐药性,应及时做病原菌培养和耐药性试验,以利于控制患者病情。     

耐亚胺培南鲍曼不动杆菌耐药性分析

目的了解64株临床分离的耐亚胺培南鲍曼不动杆菌对18种常用抗生素的耐药性。方法采用Micro Scanwalk Away-40微生物分析仪进行菌株鉴定和药敏试验,头孢哌酮/舒巴坦及米诺环素药敏试验采用K-B法。结果亚胺培南耐药的鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率最低为37.5%,其次为米诺环素54.7%,对头孢噻肟、头孢曲松、哌拉西林、哌拉西林/他唑巴坦的耐药率最高为100.0%,其余抗菌药物的耐药率均大于81.1%。结论亚胺培南耐药的鲍曼不动杆菌多重耐药严重,部分为泛耐药菌株,仅对头孢哌酮/舒巴坦较为敏感。     

我院细菌耐药性监测与抗菌药物敏感性分析

［摘要］　目的　了解该院细菌对抗菌药物的敏感性,指导临床抗菌药物合理应用。方法　监测该院2012年临床分离菌株的耐药性,以美国临床和实验室标准协会（CLSI）推荐的纸片扩散法测定其抗菌药物敏感性,用WHONET5.3软件分析结果。结果　按照监测方案,共获得780株细菌对抗菌药物敏感性结果,其中革兰阳性菌239株,占30.6%;革兰阴性菌541株,占69.4%。除绿脓杆菌外,所有革兰阴性杆菌对碳青霉烯类药物敏感率均在85.7%以上,哌拉西林他唑巴坦79.6%以上;所有葡萄球菌对万古霉素100.0%敏感,耐甲氧西林金黄色葡萄球菌（MRSA）检出率为51.1%,MRSA对氯霉素的敏感率为80.0%,对其他药物均较耐药;屎肠球菌和粪肠球菌对万古霉素和利奈唑胺最敏感(96.6%,100.0%;100.0%,100.0%)。结论　肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、肠杆菌属对碳青霉烯类敏感率较高,但铜绿假单胞菌对其耐药率较高。葡萄球菌属对万古霉素、利奈唑胺、替考拉宁敏感率均较高。     

住院患者血流感染革兰阴性菌分布特征和耐药性及耐药菌株碳青霉烯酶基因检测

目的检测和分析住院患者血流感染的革兰阴性菌分布特征、耐药性及耐药菌株碳青霉烯酶基因携带情况。方法选择2017年1月-2019年12月住院的血流感染患者186例,检测感染革兰阴性菌分布特征,通过药敏试验检测主要革兰阴性菌的耐药情况,PCR检测耐碳青霉烯类菌株碳青霉烯酶基因携带情况。结果 186例血流感染患者血液标本中分离出革兰阴性菌106株,其中肺炎克雷伯菌占28.30%(30/106)、大肠埃希菌占26.42%(28/106)、不动杆菌占14.15%(15/106)、铜绿假单胞菌占9.43%(10/106)、肠杆菌占7.55%(8/106)、其他细菌占14.15%(15/106);药敏试验检测肺炎克雷伯菌对阿米卡星、头孢哌酮-舒巴坦钠、哌拉西林-他唑巴坦、甲氧苄啶-磺胺甲恶唑以及厄他培南、亚胺培南、美罗培南耐药率低于50.0%,大肠埃希菌对阿米卡星、头孢哌酮-舒巴坦钠、哌拉西林-他唑巴坦以及厄他培南耐药率低于50.0%,不动杆菌对多种抗菌药物的耐药率高于50.0%,铜绿假单胞菌、肠杆菌对多种抗菌药物的耐药率低于50.0%;25株耐碳青霉烯类菌株中有19株检出碳青霉烯酶基因,KPC、OXA23、OXA51和NDM基因检出率分别为44.0%(11/25)、32.0%(8/25)、28.0%(7/25)和4.0%(1/25)。结论革兰阴性菌为住院患者血流感染的主要致病菌,耐药菌有集中于肺炎克雷伯菌和不动杆菌的趋势,携带KPC和OXA23基因可能是耐药菌耐碳青霉烯类的主要机制。     

新生儿病房病原菌分布及耐药性分析

目的分析新生儿临床分离病原菌的分布及耐药特点。方法住院新生儿3118例,疾病分类中以新生儿肺炎为主（65．3％）。收集其呼吸道、血液及其他体液、引流物等标本,采用VITEK2Compact鉴定及药敏系统或ATB鉴定及药敏系统对分离菌进行鉴定和药敏试验。结果共分离不重复菌株5586株,其中革兰阴性杆菌占68．O％,革兰阳性球菌占25．1％,分离率占前3位的为肺炎克雷伯菌、大肠埃希菌和金黄色葡萄球菌。标本来源中,呼吸道标本占绝大多数,其次为血液、胃液等。肠杆菌科细菌对碳青霉烯类（亚胺培南、美罗培南等）仍表现出高度敏感性,但已经出现耐药菌株。肺炎克雷伯菌、大肠埃希菌产超广谱B-内酰胺酶（ESBLs）的检出率分别为70．8％和57．4％,产ESBLs菌株对各种药物的敏感性由高到低依次为：亚胺培南、美罗培南、阿米卡星、环丙沙星、头孢哌酮／舒巴坦、哌拉西彬他唑巴坦。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南的敏感率分别为95．3％、75．4％,嗜麦芽窄食单胞菌对左氧氟沙星、复方新诺明、米诺环素的敏感率为94．3％～98．1％。流感嗜血杆菌Es—BLs的产酶率为34．8％,对氧氟沙星、头孢噻肟均100％敏感。葡萄球菌中耐甲氧西林葡萄球菌（MRS）的总分离率为41．9％,其中耐甲氧西林金黄色葡萄球菌（MRSA）占6．5％,耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）占93．5％。MRS尚未出现对万古霉素、替考拉宁、利奈唑胺、阿米卡星等耐药的菌株。屎肠球菌对抗菌药物的耐药性较严重,已经出现耐万古霉素的屎肠球菌。非脑膜炎肺炎链球菌中,青霉素的耐药率为7．7％。结论及时开展新生儿病原学监测,了解细菌分布及其耐药趋势,对合理选择抗菌药物、预防和控制耐药菌株产生、保障新生儿生命安全具有重要意义。     

铜绿假单胞菌耐药性及产碳青霉烯酶研究

目的了解医院2010年分离的铜绿假单胞菌的耐药性及耐亚胺培南菌株产碳青酶烯酶情况。方法 K-B纸片扩散法进行药敏试验;碳青霉烯酶检测采用改良Hodge试验。结果 2010年分离铜绿假单胞菌145株,主要来自呼吸道标本、脓汁及分泌物。药敏结果显示铜绿假单胞菌氨苄西林耐药率最高,达88.97%。对阿莫西林/克拉维酸、头孢噻肟、环丙沙星和头孢他啶的耐药率均超过50%。对洛美沙星和头孢哌酮/舒巴坦较敏感;耐亚胺培南铜绿假单胞菌31株,耐药率21.38%,改良Hodge试验阳性10株,阳性率为32.26%。结论分离的铜绿假单胞菌耐药性和产碳青霉烯酶率均较高,铜绿假单胞菌耐药严重     

Antimicrobial activities and mechanisms of carbapenem resistance in clinical isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter spp

We tested the antimicrobial activities of meropenem (MEPM), imipenem (IPM), panipenem (PAPM), piperacillin (PIPC), cefepime (CFPM), aztreonam (AZT), amikacin (AMK), and levofloxacin (LVFX) against 106 clinical Pseudomonas aeruginosa isolates and 64 clinical Acinetobacter spp. isolates with reduced susceptibility to carbapenems. Using NCCLS breakpoints, the percentages of P. aeruginosa strains susceptible to AMK and Acinetobacter spp. strains susceptible to LVFX were found to be 51.1% and 55.6%, respectively, which represented the highest activity among 8 antimicrobial agents in each organism. Referring to the correlations among MICs of carbapenems, MEPM showed a higher activity than IPM and PAPM in both organisms; 29 of the 94 strains (30.9%) of IPM-resistant P. aeruginosa were susceptible to MEPM. Further study for resistance mechanisms to carbapenems by the disk diffusion method using 2-mercaptopropionic acid revealed that 8 of the 64 Acinetobacter spp. isolates (12.5%) were metallo-beta-lactamase producers, while none of 106 P. aeruginosa isolates were metallo-beta-lactamase producers. PCR analysis using blaIMP-specific primers confirmed that 4 of the 8 metallo-beta-lactamase-producing Acinetobacter spp. isolates detected by the disk diffusion method were carrying the blaIMP gene. The identification of metallo-beta-lactamase-producing Acinetobacter spp. isolates implies that metallo-beta-lactamase genes have been disseminated among various gram-negative pathogens.     

In vitro activities of three carbapenems against recent bacterial isolates from severely ill patients at Swedish hospitals

To study the in vitro activity of imipenem, meropenem and ertapenem against common pathogens isolated from patients in intensive care, haematology and dialysis/nephrology units at 7 Swedish university hospitals, a total of 788 isolates were collected during 2002-2003. The distribution of the isolates was as follows: Escherichia coli (n = 140), Klebsiella spp. (n = 132), Proteus spp. (n = 97), Enterobacter spp. (n = 113), Pseudomonas aeruginosa (n = 126), Acinetobacter spp. (n = 53) and Enterococcus faecalis (n = 127). The susceptibility to the 3 carbapenems was determined by E-test, and the MICs were interpreted according to SRGA criteria. All 3 carbapenems were highly active against Enterobacteriaceae. The overall susceptibility to imipenem, meropenem and ertapenem was 90%, 98% and 93%, respectively. Against Enterobacteriaceae, Enterobacter spp. excluded, ertapenem had an equal or lower MIC(90) than meropenem. Apart from being the most active carbapenem against Enterobacteriaceae, meropenem was also the most active carbapenem against P. aeruginosa, whereas imipenem was the most active drug against Acinetobacter spp. The carbapenems are still potent antibiotics. With the introduction of ertapenem, and an expected increase in the carbapenem consumption due to an increased prevalence of strains with extended-spectrum beta-lactamases, continuous surveillance of carbapenem resistance appears to be warranted, with special attention to P. aeruginosa, Enterobacter and Proteus spp.     

Ventilator-associated pneumonia due to colistin susceptible-only microorganisms.

Acinetobacter spp. and Pseudomonas aeruginosa are common pathogens of ventilator-associated pneumonia (VAP). The presentation and outcome of VAP due to Acinetobacter spp. and P. aeruginosa susceptible to carbapenems (Carb-S; imipenem and/or meropenem) and to colistin only (Col-S) were compared in the present retrospective study in three intensive care units. A total of 61 episodes of VAP caused by Acinetobacter spp. or P. aeruginosa were studied, of which 30 isolates were Carb-S and 31 were Col-S. Demographics, worsening of renal function and mortality were not different. The univariate analysis showed that a later onset and a previous episode of VAP, prior antimicrobial therapy for >10 days and previous therapy with carbapenems during the present admission were more frequent in patients with Col-S strains. On multivariate analysis, prior antimicrobial therapy for >10 days and a previous episode of VAP remained significantly associated with Col-S VAP. Approximately 41% of the infections caused by Col-S isolates, but none of those due to Carb-S isolates, had received prior carbapenem therapy. Colistin-susceptible ventilator-associated pneumonia episodes can be effectively treated using colistin without significant renal dysfunction. This susceptibility pattern could be suspected in patients with a previous ventilator-associated pneumonia episode or prior antibiotic therapy for >10 days preceding the present ventilator-associated pneumonia episode.     

Biofilm production using distinct media and antimicrobial susceptibility profile of Pseudomonas aeruginosa

Biofilm production is an important mechanism for bacterial survival and its occurrence together with antimicrobial resistance represents a challenge for clinical management. Here, we evaluated the ability for biofilm production among P. aeruginosa isolates from patients with or without cystic fibrosis (CF) using two distinct media, besides determining the antimicrobial susceptibility profile of these isolates for eight antimicrobial agents. The ability for biofilm production when TSB medium was used was higher than when used CF sputum media (p = 0.0198). However, P. aeruginosa isolates from CF have demonstrated similar performance for biofilm production, independently of the medium used. Besides, among the biofilm-producing isolates, those recovered from CF were more resistant to the carbapenems (meropenem and imipenem) agents than those isolates from non-CF isolates.     

Resistance trends of Acinetobacter spp. in Latin America and characterization of international dissemination of multi-drug resistant strains: five-year report of the SENTRY Antimicrobial Surveillance Program.

OBJECTIVES: To analyze the antimicrobial susceptibility of Acinetobacter spp. isolates collected from Latin American medical centers as part of the SENTRY Antimicrobial Surveillance Program and also to evaluate the dissemination of multi-drug resistant Acinetobacter spp. strains in the region. METHODS: A total of 826 isolates of Acinetobacter spp. from multiple infection sites were collected from January 1997 to December 2001 in ten medical centers and susceptibility tested to >25 selected agents by broth microdilution. Multi-drug resistant Acinetobacter spp. isolates were molecular typed. RESULTS: Resistance rates to carbapenems varied significantly among countries. A continued annual increase occurred in the Argentinean medical centers. In contrast, carbapenem resistance was rare in Chilean centers, and decreased significantly in the Brazilian institutions. Acinetobacter spp. isolates recovered from lower respiratory tract and bloodstream infections were associated with lower antimicrobial susceptibility rates. Resistance rates to imipenem were higher among isolates collected from intensive care units (13.5%) than among isolates from other units. A major ribogroup pattern (521-1) was detected among eight Acinetobacter spp. strains isolated from three distinct Latin American countries. CONCLUSIONS: This study found that antimicrobial resistance is still a major issue among Acinetobacter spp. isolates collected from some Latin American countries. The dissemination of a major bacterial cluster in different regions reinforces the importance of longitudinal surveillance programs, such as SENTRY, as valuable tools for monitoring antimicrobial susceptibility rates and guiding local interventions.     

常见非发酵菌的耐药性分析

目的 了解常见非发酵菌的临床分布及耐药情况，指导临床合理使用抗菌药物。方法 2003年1月～2004年12月临床分离的铜绿假单胞菌281株、不动杆菌属190株及嗜麦芽窄食单胞菌63株，用Kirby—Bauer法进行药敏试验。结果 591株非发酵菌中以铜绿假单胞菌（47．5％）、不动杆菌属（32．1％）及嗜麦芽窄食单胞菌（10．7％）为主；主要分布于痰液（62．4％）、皮肤软组织创面分泌物（22．7％）中；耐药性分析显示铜绿假单胞菌对亚胺培南的敏感性最高（92．9％），其它依次为头孢他啶（78．3％）、环丙沙星（78．1％）、头孢吡肟（74．4％）、阿米卡星（70．5％）、哌拉西林-他唑巴坦（70．1％）、头孢哌酮-巴坦（67．9％）、哌拉西林（60．3％）、氨曲南（57．5％）、头孢哌酮（57．1％）、替卡西林-克拉维酸（55．7％）；不动杆菌属对亚胺培南的敏感性也最高（95．7％），其它依次为头孢哌酮-舒巴坦（66．7％）、头孢吡肟（59．3％）、替卡西林-克拉维酸（57．4％）、阿米卡星（55．0％）、哌拉西林-他唑巴坦（51．6％）；嗜麦芽窄食单胞菌对头孢哌酮-舒巴坦的敏感性最高（75．6％），其它依次为头孢他啶（75．5％）、复方磺胺甲嗯唑（74．5％）、替卡西林-克拉维酸（73．7％）、环丙沙星（69．8％）、头孢吡肟（63．4％）、哌拉西林-他唑巴坦（56．8％），对包括亚胺培南在内的其它常用抗菌药物均高度耐药。结论 细菌耐药有一定的地区性，定期对本地区细菌耐药性进行监测，对合理使用抗菌药物、减少耐药菌株的产生和流行有重要的临床指导价值。     

Antimicrobial activity of doripenem against Gram-negative pathogens: results from INVITA-A-DORI Brazilian study

In vitro activity of doripenem and comparator antimicrobial agents was evaluated against Gram-negative bacilli recently isolated from Brazilian private hospitals that were enrolled in the INVITA-A-DORI Brazilian Study. A total of 805 unique Gram-negative bacilli were collected from patients hospitalized at 18 medical centers between May/08 and March/09. Each hospital was asked to submit 50 single Gram-negative bacilli isolated from blood, lower respiratory tract or intraabdominal secretions. Bacterial identification was confirmed and antimicrobial susceptibility testing was performed using Clinical Laboratory Standards Institute (CLSI) microdilution method at a central laboratory. CLSI M100-S21 (2011) or US-FDA package insert criteria (tigecycline) was used for interpretation of the antimicrobial susceptibility results. Doripenem was as active as meropenem and more active than imipenem against E. coli and K. pneumoniae isolates. A total of 50.0% of Enterobacter spp. isolates were resistant to ceftazidime but 85.7% of them were inhibited at doripenem MICs < 1 μg/mL. Polymyxin B was the only agent to show potent activity against Acinetobacter spp. (MIC50/90, < 0.5/1 μg/mL) and P. aeruginosa (MIC50/90, 1/2 μg/mL). Although high rates of imipenem (53.1%) and meropenem (44.5%) resistance were detected among P. aeruginosa, doripenem showed MIC50 of 16 μg/mL against imipenem-resistant P. aeruginosa and inhibited a greater number of imipenem-resistant P. aeruginosa (10.5%) at MIC values of < 4 μg/mL than did meropenem (0.0%). In this study, doripenem showed similar in vitro activity to that of meropenem and retained some activity against imipenem-resistant P. aeruginosa isolated from Brazilian medical centers.     

Susceptibility to quinupristin-dalfopristin and linezolid in 839 clinical isolates of Gram-positive cocci from Norway

A total of 839 clinical isolates of Gram-positive cocci from Norway including Staphylococcus aureus (n = 214), coagulase negative Staphylococcus spp. (n = 100), Streptococcus pyogenes (n = 99), Streptococcus agalactiae (n = 80), Streptococcus pneumoniae (n = 127), Streptococcus spp. viridans group (n = 70), Enterococcus faecalis (n = 75), and Enterococcus faecium (n = 74), were tested by E-test for susceptibility to a range of antimicrobials including the novel antibiotics quinupristin-dalfopristin and linezolid. Subgroups of oxacillin resistant S. aureus and coagulase negative Staphylococcus spp., penicillin non-susceptible S. pneumoniae and vancomycin resistant Enterococcus spp. were specifically included as they are the intended targets for these new drugs. All isolates were susceptible to linezolid (MIC5o and MIC9o 0.25-2.0 mg/l, MIC range 0.12-2 mg/l). Staphylococcal and streptococcal isolates were also susceptible to quinupristin-dalfopristin except for some intermediately susceptible viridans group isolates (MIC54, and MIC90 0.25-2 mg/l, MIC range 0.125-2 mg/l). Enterococcus faecium (MIC90 = 4.0 mg/l) and Enterococcus faecalis (MIC50 = 8.0 mg/l, MIC90 > or = 32 mg/l) were less susceptible to this substance. There was no linkage between reduced susceptibility to linezolid or quinupristin-dalfopristin and resistance to other classes of antimicrobials. The study demonstrated a high prevalence of in vitro susceptibility to linezolid and quinupristin-dalfopristin, which is necessary for their use in the treatment of infections with resistant Gram-positive pathogens. The results were used to evaluate the appropriateness of breakpoints and to define a baseline for monitoring possible future emergence of resistance to quinupristin-dalfopristin and linezolid in Norway.     

杭州市区铜绿假单胞菌对亚胺培南与美罗培南耐药模式的研究

目的了解杭州市区铜绿假单胞菌对亚胺培南与美罗培南不同耐药模式菌株对临床常用其他抗菌药物的耐药情况。方法选取2006年8月至2007年1月杭州市4家医院分离的铜绿假单胞菌378株,对不同城区分离的铜绿假单胞菌进行药物敏感性检测,对亚胺培南与美罗培南不同的耐模式菌株进行分类统计,同时观察其对其他抗菌药物的耐药率。结果在378株细菌中观察到亚胺培南与美罗培南的8种耐药模式,分别为S/S,66.1%(250/378);R/R,20.6%(78/378);S/R,5.0%(19/378);R/S,3.4%(13/378);I/R,1.9%(7/378);R/I,1.3%(5/378);I/S,1.1%(4/378);S/I,0.5%(2/378)(S为敏感,I为中介,R为耐药)。对其他8种抗菌药物的敏感性检测结果显示,S/S与S/I及I/S模式耐药性最低,均低于10%,R/R最高,均高于44%。R/S与S/R模式对不同的抗菌药物耐药率有较大不同。结论杭州市区流行的菌株以S/S,R/R,S/R,R/S 4种模式为主,占所有模式中的95%以上,其中又以S/S模式最为多见,不同模式菌株对其他抗菌药物的耐药性有较大差异,临床可通过不同的耐药模式进行耐药机制推断,合理选用抗菌药物治疗。     

Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients.

Bacteria remain an important cause of infection in bone marrow transplants. To examine shifts in the etiology and susceptibility of bacterial isolates from transplants, we reviewed the incidence and susceptibility of blood isolates during a 7-year period. The infection rate fell dramatically during this time. Gram-positive organisms were isolated more often than gram-negative organisms, but the trend is reversing. Streptococci surpassed staphylococci for 5 years as the leading pathogen. Increasing resistance to penicillin, ciprofloxacin, and imipenem was noted in Streptococcus species. With the exception of type 1 beta-lactamase-producing bacteria and Pseudomonas aeruginosa, gram-negative isolates remained overall susceptible to ceftazidime. Increased antibiotic prophylaxis coincided with the reduction in percentage of infected patients and increase in resistance to beta-lactam antibiotics. Mortality attributed to bacteremia was low except for infections caused by P. aeruginosa and the Enterobacter, Serratia, Citrobacter group. There was no mortality attributable to gram-positive organisms such as Staphylococcus aureus and viridans streptococci.